. Relevant Docum eels Attached Received by: 6 Date: BSAS Complaint intake Form . 9:20am Time of Call: Reporter Nam Reporter Contact l? sanitation? Reporter Type lient [:ICIlent Friend or Family Member El Program Staff Person l:l EOHHS Agency other formerstafimember . Caller was advised of 42 CFR Part 2 and need for signed releases Yes LicenseelFunded w: Name Recovery Centers of America at Westminster (0399); Village inn Road Westminster MA 01473 Addresstooatton I Date of incident - alter is a former employee of the detox unit of?the program. Nat? re 0f Report hey were concerned about patient care and resigned. Caiter WHO sis they are not providing the proper care and are understaffed. hey stated there' is currently only two therapists for the whole Tait of more than 30+ clients i with the CSS programming and groups. Caller stated they were . nder the impression that each unit most have their 0er WHEN irogramming and thatgrotiping them together was not . - '1 .On?dential or individuaiized like it should be. I WHAT Frets is also no programing for the detox unit. They are grouped i . getter stated they have several people still employed at the WHERE rogram that car: vouch for this complaints vaildity. I alter stated that this has been going on for as long as they were WHY orking at the program but did not elaborate on how long they . are employed. . (llalier gays consent to use their name. Assessment and rioritization UCtient advised to complete program grievance process DCailer was referred to anotherjurlsdiotion that has authority of this matter UCalter advised to submit a written complaint Ulncident deemed vaiid oomplalnt (regulatory or oontraotuat vio lotion) {JOther EVerbatConseot van EStated No Follow Jp Provided to Caller Revisecl: 10/2015 RCA WESTMINSTER STAFFING We currently have the following open positions-to complete required staffing for both ATS and CSS levels of'care ATS Direct Care?- .4 Case Manager? .4 Direct Care .4 Counselor .8 Case Manager 1.0 On 1/3/17 we brought onboard_ who is our site specific -has extensive experience in recruiting-along with our corporate recruiting department are responsible for filling current staff openings. We are in the process of interviewing candidates for these vacancies as well as'actively recruiting. Our -and recruiting department communicate daily to assess candidates, insure interuiews are scheduled and feedback is obtained, timely presentation of offers and development oftime iines for new hire start dates. Our_ will be regularly communicating with site - leadership to anticipate any potentialvacancies and Will be responsible to develop an adequate per diem pool for?back?up I CSS SCHEDULE Wake upNitaithds Wa?ko Wake: 11pr ilaIsfMeds Wake: upNitaIsiMeds Wake upNitalsmIeds Wake upNitulsfn-{cds Wake upNitalsfMads Brawn-dads Breakp'Meds Breakaeds BmaWeds Break '4 . . Break r. Break Break Bmakmie?s Primary 10:30 -- Breakacds 12:00 Primary 10:30 {2:00 Primary 10:30 {2:00 Primary 50:30 .1: 12:00 E'rimary 16:30 - 12:03 Lunch Lunch Lunch [PhonelComputersj Lunch (PhandComputm-s) 1 Lunch (Phoneanmputem) Lunch (FilendCompulm) Lunch . {PIEDneICamputers} Open Gym?Rcc. Group Fitness Open Recreational Rec. Time Open Group Fitness Open - GymIRcc. Open Gyml?ec. Time Open GymIRcc. Time G?nmem'l?lme GymIRcc. Open Time Rec Time Time Spiritual Adviser Yoga Yoga Dinner Dinner (lenea'Compu tars) Dinner (Phone?omputers) Dinner (Phqna/szpulcrs) Dinner (PiloncIComputezs) Dinner {PhonelCompulcrs} Dinner (PiloncIComputers) . Recrea?annl'?me NA .. 12 Step Racmatianal Time Recreational Time . (CumputerfPhone) Recreational (ComputerfPhonc) Ree. {Computer??hone} Time B1g Aa - 12 step AA Big Book . Book Saber Fm: NIght lesite AA Activities (movics, . games etc.) I Rec?guma?ng. reading, stepwork out Madleighas out out Medleights out Mcds?jgiils out . qusmighis out MedsILights out Lubega, Agnes (DPH) Sent; W-dnesday, February 15, 2017 4:00 PM .- To; Lu age, Agnes (DPH) Subject: . RCA employee letter i Hello Agnes, For your request: I was unable to speak with you the days that BSAS was there for their investigation. Although I was working on these days, I was asked to "bid and stay in my of?ce. I was hired as a recovery concierg and was given a jab description on 8-22-16 My position was classi?ed as nonrexempt On the day of openi I was toldI Would be the "?nancial analyst This position is classi?ed as exempt My job title has changed 11 several occasions, none of Which I have ever eed to Upon opening in late October I reported all concerns to my supervise 11 an ongoing basis My camera is Involved patient ?nanc questions of fraud, medication diversmn staffing safety, patient safety, and general operations of the fact] ty including no heat no Hot water no illows, no blankets, etc. Suervisor irected concerns 11 he chem ofcommand unexpectedly let go. Since that ti other staff that have reported questions of unetblcal behaviors, patient safety, and illegal behaviorsgto co crate or otherwise have been tenninated or forced to leave. . Upon questioning the fmancials: a eci?cally collecting out-o?pocket maximums, setting up. payment plans on claims that have not yet occurred, 1 ill ing upfront for services that-have not yet secures, and questionable practices of patient brokedng rela rd to the suspicion of taking cash for patient referrals as well as patient warehousing of patients who kno ingly or not suited for a facility, [began documenting and keeping detailed. notes, copies of emails, and collat ral infomation regarding these unusual and suspicious activities. Patients were reporting to me as 11 as admissions that they were not made aware we were an out of ?rework facility and therefore refused to at ?nancial statements. Patients were also unaware they were being shipped to other facilities they had not agr ed to During a conversation wit "3 expose ing my concerns in 1egards to all above especially 11111111911113 - - me to "dance around the ?nancial and the fact that we Were out of network she stated We know the patient is not going to pay the amount owed however we need to look at the big picture which was getting paid at a much higher rate due to being out of no 0111:. Witness to this conversation was the ?nancial analyst/counselor from the Beavers RCA facility an In the last four months, 23 of the ?giual 40 to 50 staff have been ?1er go, forced to resign, walked off the job immediately, or resigned due to 111 concerns I have listed above. Agnes, thank you for your time today and as always There 13 much more that I could say wid?n this email and in other conversations we may have yet to heme Should you have any questions 01' require additional information from me, please do not hesitate to reach out as always. - - On Wednesday; February 15: 2017 1:38 Pm; Lubege, Agnes mote: Thank you for th is email- We shall ?allow?up accordingly. Agnes Lubega i Complaint Investigation Specialist Massachusetts Department of Public Hellth, Bureau of Substance Abuse Services Quality Assurance Licensing 250 Washington St. 3rd Floor Boston, MA 02108?4619 P: 617-624?5056 i F: 617-624-5599 Ag nos. Lubega@state. ma us Website: Mass. gov/DPE . Biog: htto: state ma d3 1. Con?dential Complaint Lines: 5 Phone: 617-624?517] Helpline: Telephone: 1-800-327-5850 Sent: Wednesday, February 15 2017 . To: Lubega, Agnes Subject: RCA employee letter i Hi Agnes, - . Please see the letter below from a staff member at RCA Westminster. This letter was just forwarded to me and asked to be forwarded to on. it is not only heartfelt but ineredi 1y honest and truthful. Thank you in advance Bogln lom aided mossogo: wrote: On Wednesday, February 15, 2017?. 1:03 PM, Date Februar 15, 2017 at 12:57 02 PM EST Subject: Letter of resignation . Reply-To. - Excerpts from my letter of resignation 1 Please understand that I am writing this had stocked away for when I needed it. after many many hours of analyzing and re?analyzing my feelings towards my employment and my feelings towards the practices of this corporation which without a doubt in my mind has crossed into the unethical. be comfortable using the word ?unethict are at. have spent the better part of 3 . the foundation ofmy own recoveiy. I a: learned to be mindful of not only my the well as my intentions. in the beginning ?cosy? has only been a few weeks), my and kindness. i felt as though there Was need. This was obviously my naivety ta corporation could be at its ?good RCA has been motivated by, no surptist decisions of my own behaviors, ti worked really hard at changing, have re; lack kindness and compassion to top it: embarrassing for me to admit thetl con. this point is my honesty. Speaking of honesty,,here we go. For me, recovery is personal. I think it affected by addiction. I would have the ,4 It is not only ironic, but depressing that a former drug addict can 1? and not direct it at himself". Unfortunately, that is the point we ears tryio to adopt more positive behaviors and attitudes which is for from perfect, but in my chosen path of recovery I have tights and actions, but the causes and conditions behind them as ofrny time at RCA (it is so sad that the ?beginning? oornpared to houghts and actions were preempted by positivity, compassion, good to be done here and that we would be helping those truly in king over allowing me to be swept up with the idea that a Many of the practices and decisions I have seen implemented at here, MONEY. Since witnessing the unethical practices and loughts, actions, and intentions behind them all, which I have grossed and reverted back to negativity, distrust, anger, and now I Eff. I am not liking the person I am morphing into and this is be beaten down so quickly, but the last thing i' to holding on to at 3 much more potential for those of. us who have directly been ught that as arecovery center we would have been more focused on being successful treating patients than sing successful as a business. The sad thing is that if our primary focus was on the patients, the business end Would take care of itself; but the corporation decided to put the can before the horse and it has completely back?red and has become embarrassing and demoralizing to be a part of it. One thing RCA needs to learn is that more importantly, dangerous to believe 5 ok to believe everyone can recover; however, it is gullible and, everyone can recover RIGHT NOW. True recovery comes lion: withhi and inside a person needs to pre eat a fairly strong aspiration to be clean and sober. The only thing our patients need is a method of payme willingness and desire to be clean and 3 run outwith zero assistance in plannin going-right now? quite a few times in extremely unethical. Yet we allow the stated that they were only there to get In addition, the scam that is wicked so missed any?) Patients have told storie promising of ?We will send you 2 date It. Too many times I have seen good people with a strong her be removed from our facility the minute their payment options on what to do next. have been told have no idea where 1 am is exact circumstance. This-is heartbreaking, unacceptable, and roblem patients who have payment methods (many who have eir money) to stick around and infect everyone else around them. r, banyao, northeast recovery, and RAW is just offensive (have I of gettingykiekbacks to complete detox. The human trading and patients, but you have to send us back 3 for our sober living facility and once they relapse we will nd them back to you for detox again." No one can tell me that this isn?t true. Again;.. this is a fact and it disgusting to be a part of it. There have been several occasions where we receive several patients com? from the same facility after a relapse. They all know each other, they were all told they HAD to go to A. in fact we had a patient who explicitly told me that he Was strongly suggested to use a?er 50 days lean so he could be with his friend in detox. It do can?t take a (BA agent to ?gure it out. . We were suppos to be different and We are not only the same, but we are better at being worse offenders oftbe status quot The phrase ?we are a start-up" is no longer an acceptable answer or rationale to every negative situation especially when the situations are regularly repeating themselves. Dangerously low staff to patient ratios coinciding with a strict ?hiring freeze", educating patients on I method of recovezy and plastering that 1 method and i method'only in every group room there is, minimai to no consequences for negative behavior especially if they have favorable insurance, lacking of imperative supplies, lacking premised goods and services that still remain on radio commercials and the website misleading patients, dishonest historic re?ection ofour ?rst femaie patient per i adic commercial. These are ust a few things that when questioned have been met with ?we area startwup. The bugs are still being worked out.? In any path of . recovery the principle of honesty is integral, yet as a business we ourselves cannot practice it. Recovery requires addressing behaviors, but even he majority of the patients who have had the funds to ?successfuily complete the program? leave the exact 3 one person they came in as only 30 days ciean. . .. We hope they are ciean who really knows Fcaosc of the checking of medications only to be passed on for ?nancial and physical favors from the residential patients? Being a recovery center requires adequate staff and services as well basic necesSary sap alien to be'oifered such as things like medications and clean towels which we are constantiy running out ofllaving. We are ester promised and understaffed. We are a "thank you. .. come again" convenient store style business. We are overquali?ed, yet undertrained. We are a ?team", yet undermine each other. We reward disreSpect with more attention and whatever; We are a boohjob, aesthetically pleasing with only arti?cial substance behind it. We are money cenn?ic. We are a heath care organization who forget our promise to do no harm. Part of doingn hand is not accepting patients who are inappropriate for our services, but we do so anyway because they can pay. We have gone from being disappointing to just being disgracefui in our actions and intentions soon not include me. -- II?nwm?r Lubega, Agnes . Sent: Wednesday, February 15, 2017 10:05 PM i To: Lu]: ego, Agnes (DPH) . . r? Subject: Roe I i Good Afternoon Agnes, Tracy and Jim! It was nice speaking with you guys and i can hear the concern in your voices as to the situations at RCA . Westminister . As you know per our conversation i was ?red from RCA on the 24th of January . I feel that this was direct retaliation for my advocating for my patients rights and dignity . I had brought numerous concems to the attention of leadership and nothing was addressed. 1 contacted the corporate of?ce and spoke with hr and informed them of the situation. I told hire that I knew I would be retaliated against but 1 didn't care as long as the patients were safe Throughout my employment 1' cXperienced many different types of situations . At first i was hired as a case manager but told I needed to be a recovery support specialist on paper due to licensing . i didn't feel comfortabl .. with this as i was unable to do my case management responsibilities 100% as i was expected to be a on the ?oor. Being paid as an rss, listed on schedule plus listed as the detox case manager . tunity to really get to know my patients and Ictthem knowi was there to torrent . My main goal was to secure safe long term aftercare arrangements for i was eXposed to the human trafficking of substance abuse patients . Patients coming to detox with plans to detox only then get shipped somewhere else and so on Sickening in my opinion as alot of patients and families we re not aware they were victims of this This making it very dif?dult to provide case management for the best of the patient As a case manager i had the oppoi support them throughout there tre them. This became very dif?cult: roility, it became very unsafe at times as we were so under staffed and at times - Sta?ing was a huge issue in the ti erving as the case manager and res. This happened often and was reported on i was the only person on detox Thanksgiving as i felt we were or stressful and staf?ng should be it was yelled at by the acting see as of?ce Monday morning . pt prepared to serve our patients. As you know. the holidays are extremely creased or at least at licensing approved . A?er i reached out for assistance i this was "inappropriate behavior and i should- be expected to report?to his to the acting clinical director to scalate me to a level to be ?red". From then on, he attempted to engbarrass me in meetings, excuse me of not being in meetings and commented as they were not monitored becat A patient was also assaulted by a assaults resulting in extended per The cec heard the commotion an produced patients remained in 1 Unsupported as she had heard of Due to low staffing there were alto situations where patients were preformiog sexually inappropriate behavior so there was no staff. pother patient A 40ish year old man, 200ish pounds with a long history of iods of jail time physically assaulted a 20yr old lZOish pound young adult. responded and enquired about the situation. No incident reports were rcatment days later this was brought to my attention by a that felt the situation ,reported it and it was dismissed. it Substance was also found in patio ts bedroom and staff was ordered to disregard the situation as we can?t - remove the patient because we wi loose money. I was put in numerous situations here I was orders being approved to come to treahne that they were unable to pay, afte medically safe to do. to discharge detox patients within hours due to the fact at . Extremely inappropriate and not l?atient? comes into treatment ma 24yrs old, alcohol and neurontin being his drug'of choice . After 2 days in detox patient was presenting with of nodding out, bed with nursing it was discovered th the patient had dependence issue . I was told not 0 say anythi wetting and erratic behavior . After speaking been put on a s'ubutex taper protocol without having a opiate ng and there was no problem as the patient indicated that he had - tried percocet in the past. Thats they justi?ed the situation . Although the urinalysis test Was negative upon admission . Numerous patients came to me situation to tour the country . As i: agreement that they would be "tak They would be transported to diff - I had a female client who told the promissory note to insure additior advocate for her and ?nd out. As would be stressful I Was told by Another concerni had was the fat a history of crack cocaine usage a not be completed if he was using told not to proyide any case maria patient of his. Throughout his stay into patients rooms but yet was st appeared over medicated . It was to 4 times daily for" pain. This can condition . He became so out of - a day. This was paid for by?his fat [ting that they were aware of the patient brokering and they were utilizing the hey wouldenter treatment with the support of the marketers with the on care of . sre?nt states to utilize?there insurance bene?ts . that ontop of the insurance coyerage she was required to sign a 9000 dollar tal payment . She was unsure of why she had to do this so I told her i would the was a 19yr old, unemployed, ?rst time detox patient i can understand this leadership to mind my own business and this was procedure that a patient was just being ?housed" in the facility . He was diagnosed with ad was awaiting a upcoming surgery . Due to the fact that the surgery could substance he was allowed to pay privately and stay at the facility . We were gement as the doctor at the facility Was in charge of him as he was a private rhe had destruction of property threatened to rape staff, attempting to get ll allowed'to stay. At times it was observed that he was nodding out and brought to attention that he was being prescribed a large dose of suboxone up sad a extremely dif?cult situation as other patients would see him in this ontrol that he was provided a outside one on one aide to tend to him 24. hours nily . We were told that he and his family had an endless supply of money and we were to do whatever we had tt clinical appropriate . It was observed on the daily can 1 to keep him in the facility although it was said numerous times that he wasn?t case manager "that was unfairly terminated" was assigned to him. In a clinical treatment team eating this Was brought to managements attention and they made the correction to .dele would have to assign me as his manager on record. 1 was his true case manager andi to the assigned truer case manager . At'that time they informed me that due to billing they 3 that afonne as not to iugage in any was told that it was no big deal because the doctor aftercare planning. I have documentation of that as well . But it didn't matter when fired me for lack of case management to this patient I was written up for neglecting Leaving them with no case mane ement or patients in a situation where the the work with thorn so that was after care plans. it was a common prob manage unfortunately-the acting clinical irector didn' lent that there was only 2 therapist and th - patients. We Were told that We tied to step it up an ment on numerous patients that were not eyen assigned to me. assign patients for sometimes at least 4 day after they arrived . therapy during there stay at detox . This unfortunately put the tential to? relapse was hi gh, Then they had to blame someone for not doing a. If they were assigned we could of attempted to work with them to create ants had not seen a therapist during there stay; As it was quite-dif?cult when could not handle all the patients . As case managers we had at tirnes 20+ assist the therapists by doing there treatment plans and 2 i bio assessments so they would he done Sometimes this was done on the date of discharge, which obviously meant that the patient had no treatment while at RCA because concerns were not noted until discharge date We started with 6- therapist down to 2 4 case management down absolute shame the way we were targeted and treated poorly when onestioning "safety and programming of the facility We were told not to contact hr or there would be retaliation Absolutely sickening We all watched Wonderful staff be set up and ?red on many occasions . There are'so'many individual situations i could go into, my email Would last forever. I do have many emails and documentation to support the onethical practices that were going on. At the end of the day, my hopes a dreams of the potential of this facility being the best eyer have faded away. We all were mislead and made to ork in- a hazardous enviromnent . It saddens me so much as i should be there advocating for the patients and helping them through this rough time in the recovery process . But unfortunately i was labeled for standing up for patients who couldn't advocate for themselves . I could never morally or ethically work for RCA again but i would go back to the facility under different management tomorrow if I had that Opportunity . I am quali?ed and know the position Well . My member one focus will always be patient care they will be allowed dignity, respect and get the care they deserve . Please keep me posted on anythin 3' else I can do to help Im not sure how this process will proceed, do you shut them down? Remove all employees and take over? or relocate patients - I am more than willing to help any way i can. lhaye been fired and just want my job back nun.? .. .. 'Lubega. Agnes (DPH) From: Sent: rsday, February 16, 2017 9:52 AM To: tut ega, Agnes (DPH) Subject: For your request Attachments: For BSAS.docx Hi Agnes, - Per your request to document my xperi once at RCA Westminster, I have attached the following Word Document. I apologize as it may i scattered; however, there is simply so much unethical and illegal activity that occurred, it is very dif?cult to capture it all on paper. I have pages and pages of text mes sages supporting that I made corporate aware of the many, many ongoing infractions prior to and up to the others'have experienced the same in 26 years inthis industry, I have being hurt by dangerous, unethica I am not at all bitter about being It moved on, Beyer brought any core forward to cooperate with the former staff who I adore. This facility should be closed and but for the sake of their care and 3 1y that I was told it "wasn't working out? and I was let go. Since then, several Fate: talk too much or know too much and termination is imminent and swift. never experienced anything like RCA Westminster. Patients and staff are and at times very illegal behavior, it go? I could riot work for this company alter reporting what I knew. I have plaint forward; but, enough is enough. I feel at this point, I MUST come its investigation and corroborate the claims being made and proven by my be relocated immediately. I realize that is a large undertaking critical to their successful recovery, this is a desperate situation. The leadership is not competent or experienced enough to successfully turn this grave situation around, they are harnessed by corporate administrt NOT patient care. If I can be of further assistance or tioa who turn a blind eye, lie, and deceive for the bene?t of the ?nancial gain you require any additional support of claims, again, I have pages or discussions and dialogues to corroborate. Please do not hesitate to reach out; ?hm?u. . Hostile Work Environment 1 Thursday, October 20th, outdoor deck at Wachusett Mountain - asked to speak with me and told me that corporate got a call from Spectrum suggesting that have a non-?compete agreement. He asked me to produce the document and provide it to him at I which time he could get it 10 corporate and ?corporate will decide if they want to fight for you or not. That was the end ofthe conversation before he stood and walked inside. 2. Wednesday, October 25min - office with - a - to discuss the struggles in our working relationship. me with my team, extending offers to my staff without my knowledge could not apoiogize, could only say ?my bad? and at the end oi?the meeting reached to hug me and said ?it wili all be ok my girl Described incident of being referred to as "my girl? which made me uncomfortable I via text message 3. Friday, October 28?? while In the Birch conference room, 1 was conferring with - . medication because his behavior had been aggressive, he appeared possibly high! confirmed what medication he had been given to insure with the nurse that his medication was not the cause of his behavior When i turned around after completing this conversation me "What do you have a medical degree now?? i said ?No, [was going over medication . because he' 15 struggling clinically.? His response was ?this is exactly why i have said that you need to make decisions as a team!? 1 replied, there was no decisions being made: i was just - what meditations he had taken.? that master keys were being given to his two leadership team. lreportz- take care of it, that would Retaiiatory Actions AL suctspeed violations i - . .- -. to report concerns regarding mistreatment of ring, fraudulent ?nanCIal reporting and activity, patient safety, mistreatment -- - - .Medlcation diversion, vioiations of Safety- Medications, Viol tions 1 November 5th nurses sta ion on detox, - - - is discussing a patient? 5 medital issues at the nurses stati with other patients present The patienti di scloses to his case manager, that he feeis. is right on laiity Was violated and against HIPAA __a1so witnessed the incident rsonaiiy. was confronted via email by - - - and Dr. stated th it was a facility issue, no privacy, and there was no other patient present Tuesday, November 8th confirmed- account ofthe incident personally and reported the HIPAA violation to CCU via text 2. The facility does not hay authorization front the DEA to stock medication yet. nurses and Recovery Support staff a sent to CVS using their own money to pick up prescriptions of narcotics and . Facility I 1.- 5315359!" 6 7. 8. 9. 10. Staff using personal monei I Nursing 1 AdmIssIons/ Referrals . patient T0 Wh! October (guess), patie ntnwants to leave against medicai advice/against clinicai advice. . .. II I I private vehicle alone, to the train station and buys him a ticket to Somerville benzodiazapines (controlleiti Substances). Many staff are in recovery personaiiy Not is this just an issue of buying patient medications with personal money, it iS aiso an issue of chain of command for staff who are not licensed IInedical professionais carrying narcotics (ie, if the pharmacy was off count . and a piil was missing, the when staff must leave the requirements Licensing requirements for staf?ng are not being met as counted as line staff which Was hired as a Patient Advocate/Concierge, etc. Staffing requirements of licensing NOT MET. appear as though requirements had been met by using nurses to cover Recovery Support and Case Managerhours,etc. Patients in detox had no in Patients had no televisions Patients did not have launI There was an inadequate The kitchen did not pass ti 3} take out menufor every hot chocolate) Cockroacheszermites am: No bed bug check when itaff could lose his/her job~ accused of stealing medication) facility to obtain medication, the milieu Is understaffed based Ion licensmg Is misrepresentation. Case Managers have deal roles, Financial Counselor lied on licensing application to make it at waterIOctober 2748*. Late Friday evening it was restored. in their rooms, no cable tv service. iry capabilities until November 4th. umber of pillows no'comforters on the beds Board of Health inspections As of 11,19, patients were still ordering from . meal They cannot have any drink except water (can make tea coffee, or . Patients complaining about the lack of healthy snack choices chips, cookies, and granola bars no extermination contract; ants in Director of Nursing office (10/27) I asked i was told via email that we have one and a designated space. No bed bug covers on mattresses rto purchase toiletries, paper toweis, soap, personal care items for patients, laundry detergent, activities like coloring, sports equipment, etc October in NP Office - who was very upse patient who had left the fa afraidiof'iosing his license prescription particuiarly Monday, November 7th, are he uses heroin and Stated that a patient who needed Subutex was given the subutex from a cility and he was unable to. do the med counts without iying. He was also due to that practice being illegal: given one patient another?s patient?s ven it is a controlled substance . ies, ",ok oh well crack and comes back to detox the following day. November comes back to detox and is mistakenly given 24 mg of Subutex for opiate withdrawal (thice the limit of the dosing protocol} Nursing staff untrained, ir experienced; e'xpe?rience I has no substance abuse treatment 1 Accepting patients witho ?t medical review for appropriateness {medically complicated) 2. Pre-arranged courses of re being tiny?? hr raf?e?? Pt brokering, not a new issue for- from I - .. . - Question of referents driving patient Other . staff etc Reported that . care instead of clinical nec ssity. Accepting money for referrals to various locations; patients unaware of their course oftreatme Patients being obtained through false advertising on Craigsiist for sober housing? told they need detox first, driven to RCA Accepting patients with seI severe Issues as pay mental health patient . Receiving payment for sen. before receiving all treatm ious acute and chronic medical concerns? chronic a-fib, recently off 02, primary diagnosis, unlicensed part of facility to warehouse a cash alone. ices not yet rendered. Chapter 258 patients being moired out of treatment ant they are entitled to - with sexual trauma historyI offensive, advertising, dist text who oversees ali med Boundary issue with the I patient ?he is just so attrai was dressing inappropriately, patients (some females very uncomfortable with him no underwear pants much too tight- rbing to patients and to staff. Reported to Her response was only that is a God to her. ctor? reported to discussing with me his private ive, he has these beautiful steel blue eyes,_he and are going on a hike together on Sunday inaypropriate boundaries with patients. 1 have all texts between reported to me. He admitted that he has been "leavin inclusive of her.? self and and other during a meeting with he an that he has not been fair to out of things, and that Is my fault, i need to be more Patient left on the second day stating that he liked the place, liked the staff but "just not ready to accept patients, have no t-chen, no hot water, no not right now.? Recovery Support Speciairts chronically understaffed but levels, stating that staff wit and supported by the issu i would come back if] needed help but just . ould not allow for appropriate hiring other titles can "be? RSS, can case managers? documented In email of many staff having multiple job descriptions. MyJob description signed on 9,!20 states that I report directly to theNP of Clinical Serviced (a vacant position at corporate hear quarters) That position is supervised .. - - and was offered (along with a suggestion regarding relocation real estate in PA) as a way to get out from worlcing for the ?docs The Members of them no just cause (because I a [Leadership Team inclod writing). - Nursing failing, operations failing, failing, and clinical program received ados for Successful treatment of patients to date yeti am terminated with reporting violations that i was told to "Reed In house? . Defamation of characterIRe-put tion 1 Rumor that i was release and walked out on the same day as_-was demoted and removed from RCA is an i dication that i was somehow involved in activity with- I ve been in this industry for 25 yea 5 and have another 20-25 left. Reputation is everything. 2. At an all staff meeting held on Wednesday, November 9? following myterminetion, it was announced that the .- - -. . . and were no longer with the company was because there were some "disagreements and' Issues between them that could not be resolved STAFF TO CORROBORATE St Chara ter witness i' and others atthe corporate office were threatened with termination If they spoke to me after November 9th.. I have maintained contact with any staff at RCA Westminster since November as most of them reported to me. The entire clinical team exce at for niece} and 1 clinician have left since I. was terminated. Days before my termination,?l received written kudos by valued I am, appreciated-and respected by everyone at corporate. Lubega, Agnes (DPH) From: Sent: To: Cc: Subject: .Th. Dear Agnes, I am writing this email as a follow My understanding is that this racer recently ?led against RCA, During this meeting we discussed 1 to unsafe staf?ng, patients and stat lack of training thus patients are of times .Iaddressed-tbis-with Wes able to hire dueto hedgetiog and staff who left RCA and were tenni staf?ng for in excess of 6. weeks. I As a follow up to our meeting wilt}: WI visited our site and rcqu .- we discussed in detail T116135 was my lack of knowledge of who working close to 80 hours a week a non?exempt hourly employee. Tr health visited yesterday? To that I i I rseaay,teraaya12o17 11:54 AM ow up email reqUest up to our recent interview at Recovery Centers of America @Westminster. it site visit and meeting was in response to numerous complaints and lawsuits a detail the current unethical behavior and practices currently ongoing. Due safety was exposed daily. This lack of staf?ng also exposed a signi?cant tntinually not presented with infomation for lasting recovery. Upon the 100?s tminster leadership and corporate management I was told that we were not nanee. This continuing critical and problematic situation lacks urgency. I had mated due?tocause however not allowed to rehire, thus exposing holes in was personally attacked due to this and attacked due to training. i the department of public health, our corporate ested a meeting with me During this meeting iues at hand, staf?ng and the Speci?c details as noted above Also discussed my supervisor was, lack of supervision, as well as the fact that I have been 1nd being paid on salary while as supported by my job description should be - he stated "where you this honest when the department of public responded, "yes, Absolutely I was" - It is no surprise that less then 2 weeks after this meeting, I was tetminated. This is no better example of workplace retaliation. "Your empl: empioyers alleged violation of the attorney Additionally, your emple proceedings." aycr also cannot rightfully retaliate against you for the reporting the FLSA (or a state equivalent) to an enforcing labor department or ?rst to your yer cannot rightfully retaliate against you for participating in resulting 1 . . This is truly an unfortunate situati 11 of legal, unethical and ?nancial misconduct on the part of Recovery Centers of America, both Westmi ster leadership and corporate management. Respect??ly, INTAKE: Reporter: INVESTIGATION REPORT. Date: 21mm 211611715 Employees . Agencyiprogram: RCA Nestminster -4 other previous Contact:- Regional CEO Addreso: . 9 Village Inn Road Westminster, - 1W3. License [3399 Funded: IYes No 'Phone:__' CISI BSAS staff: Jim Ht [ganIAgnes Lubega Complaint Cot?plain?lncident: Complaints about staf?n Required Noti?cation and client care SCREENING: FEE?lid. Not Valid FACT FINDING Sito visit on 211/17 mm Investigation Process Tour of facility . ?tat-Ito; Documents to Review: Staff Roster for toth programs identifying positions Staff schedule for both? programs all shifts Client Roster both programs . Client chart both programs Org chart for both programs Staff-chart inducing training info 1. [318 team met wi program management IL ?mm?M INVESTIGATION REPORT. Supervision Notes Group schedule for both programs (Have stafi identify which group they do) Staff schedule for Nov?- January Med log Employee Handbook {Hiring policy) Client handbook Admissions criteria (tees) Incident report sin 3e Nov 2016 Grievance since i\ ov 2016 SUMMARY: 1641044 Supervision and training Based on the review of staff supervision notes there was no documentation of plans for professional growth and development for Acute Treatment Services (AT8) or Clinical Stabilization Services (C 88) staff. 164.843 Staf?ng Patten Document review and interviews identified that neither 038 nor ATS has-the required staffing. There is one case manager that provides Services for both (388 and ATS. There are two therapists/ counselo that provided serviCes to both ATS and 038. During the investigation 13 interviews were conducted not one staff perscin couid identify a program Director for eitherihe ATS or the CSS '3 164 083 Client Record Record review Identif ed that group notes are not consistently being documented or that grows are not occurrin according to the group schedule provided to CIS Some of the group notes that re owed did not provide the required information about the group session and progress of client. Of the 5 charts that wer reviewed the documentatiOn was mostly based on clients engagement and partici ation in groups and not individual notes There was no documen tion of STD TB Viral Hepatitis HIVIAIDS education overdose prevention as required for'either ATS or CSS. .164 074 Min TX servic Through document revi and interview it Was vent" ed that a male and female 088 clients engaged In sex I one of the bedrooms; which demonstrates a lack of oversite that ensures the health nd safety of clients. Case management is not occurring to ensure quality of care. There is one case manager that provides services to'both ATS and C88 clients. INVESTIGATION REPORT Substance abuse therap es, counseling and education which to accepted standards of cate?are n01. occurring on a regular basis in either ATS or (338. 164.302 Provision of Services . Document review identified the program is not conducting a review of the clients prescription monitoring" program as required. - 164.073 Treatment Pier ning In reviewing client recorcs it was identified that some individual treatment plans are not . being signed off as required in above regulation. 164.0?0 Reform-land Admission itwae identified that client charts for ATS and 088 had no information or docomentation about the range of treatment options includingMAT, the risk and bene?ts of MAT end the risk and benefits of not receiving MAT. Staff members are not creating conversations with clients around MAT optima.- 164.079 Client Rights . During program tour and document review it was identified that the BSAS complaint line was not posted in either the ATS or the (388. 164.081 .Ciient Manual . Client Handbook for and-CSS does not provide fee policy as required in above regulations. - CONCLUSION - Bl Substantiated I El Partially Subgtantieted - . Not Subatantiated REPORT - DEFICIENCY CORRECTION ORDER (oco) DCO lesued: Yes Date of DCO: lf D00 is issLIed, referen 164 044 Sopewision an at training A review of staff supervis for professional growth Clinical Stabilization Se Through interviews it vv training before they can Required Documents: Provide a plan with a ti supervision and doourn - supervision form to be with bio/resume and dot sheet. Describe how program 164 043 Staffing Patte Document review and In required staffing leveis There Is one case mana ion notes revealed that there was no documentation of plans development for Acute Treatment Services and (ATS) or ices (088) staff 5 identi?ed that staff are not given the proper orientation and ork on their own to take care of clients. A line for ail staff that provide supervision to be trained In tation of supervision Submit the following: a copy of the ed to document supervision notes name of training, trainer of training; length of training, trainer expertise and sign in ?iil? provide proper on boarding for all new staff. erviews identified that neither C88 nor ATS has the BSAS or that provides services for both (338 and ATS There are two therapists! counselors that provided services to both ATS and 058 During the investigation, identify who the ,Pro'gran Required D?oc'uments: Describe how the progrs staffing guidelines. The - abuse treatment service Submits program organ sohedule'for all shifts foI 164.083 Client Records Based onirecord review documented or that to the investigators. Son 13 intervieWs were conducted not one staff person could I Director for either the ATS or the 088 was will ensure that both ATS and CBS wilt comply with BSAS jescription should demonstrate how comprehensive substance 5 will be provided until both programs are at full staff. capacity ization chart for both ATS and 038. Also provide a staff the month of March 2017 for both the ATS and 083. it was identified that group notes are not consistently being me are not occurring accordingto the group schedule provided to: of the group notes that the investigators revlewed did not . INVESTIGATION REPORT provide the required?infor example, some group no group. During the investigation, to meet with a therapist i: Of the 5 charts that were engagement and particip There. Was also no docur overdose prevention as Required Documents: Submit a plan with a time of progress notes?and gr with biolresume? and date Sheet. Submit a plan with timeli Prevention education wil needs to include how st education to clients. In a trainer with bio/resume in sheet. 164.074 Minimum treat Through document revie clients engaged in sexi that ensures the health Case management, indi case manager that provi - provide counseling and individual programs with treatment services to bo Substance abuse therap ?standards of care are no Required Documents: Create a quelitylassuran The plans need to includ contact between clients. . Submit a pian that identitl and education which con mation about the group session and progress of client. For tee-did not identify group topic and client?s participation in the interviewees stated that they have had to request and also wait ecause the program does not have enough staff. reviewed; the documentation was mostly based on clients? ation- in groups and not individual therapy. . nentation of are, Viral Hepatitis, HIWAIDS education, equired by the above regulations for either ATS or CSS. r-line to retrain all staff in both ATS?and (:88 on documentation Jup notes. Also submit the following: name of training, trainer of training, length of training, trainer expertise and sign in to how STD, Viral Hepatitis, and Overdose be integrated into the ATS and 038 programs. The. plan will be educated on the topics in order to provide the dition. submit documentation that entails: name of training? date of training, length of training. trainer expertise and Sign ent services - . and interviews, it Was verified that a male and female 088 one of the bedrooms; which demonstrates a lack of oversight nd safety ofclients in the program. - ual counseling and 9mm are not occurring. There is one es?services to both ATS and 088 clients and 2 therapists that roup to both the ATS and CSS. The ATS and (388 are eparate licenses. Staff cannot be providing substance abuse programs during the same shift. - es, counseling and education which conform to accepted Occurring on a regular basis in either ATS or CSS. id as plan to ensure the health and safety of all Clients Ia?ndstaff. how the program will prevent future incidents like sexual es and ensures that substance abuse therapies, counseling rm to accepted standards of care are occurring on a regularw ., to REPORT basis in ATS or CSS prog 164.302 Provision of Se Document review identifi: preeoription monitoring Iram. rvicee ad that the program is not conducting a review of the clients ogram as required. - Required Documents: Submit a plan to ensure at a Prescription Monitoring Program review is compieted for each client for each adm eion before initiating treatment of opioid dependence with agoniet or partial agonist medications . 164 073 Treatment Pie ing in reviewing client reoord it was identified that some individual treatment plans are not being signed off as requi ed in above regulation.? 'Reduired Documents: Provide affirmation that Submit a? plan to ensure: 164.070 Referral and At It was identified that clier aboutthe range of treatrr the risk and bene?ts of members are not creating The program?s denial log individuals that had been pregnant ciieot who was client was not appropriate had been provided to the Required?Documents: . Submit a plan to retrain a. following documentation: length of. training, trainer oatment plans will be signed by all required participants. Ill treatment plans are being reviewed and signed [mission . charts for ATS and 088 had no information or documentation ent options including Medication Assisted Treatment (MAT), AT and the risk and benefits of not receiving Staff convereations with ellents around MAT-options, did not indicate any information on referrals made for denied admission into the program. For-example. there wee a denied admission with no supporting information as to why that I for the level of care. nor was there evidence that any referrals client. Ilstatf on Medication Assistance Treatment and submit the name of training, trainer with bicfresume and date of training, expertise and Sign in sheet.? Submit-Ia plan to ensure ihat clients will receive the information as required in above regulation. Describe how program 164.079 Client Rights During program tour and ll comply to regulation 164.070 (E). document review it was identified that the BSAS complaint line was not posted In either the ATS or the (388 REPORT Required Documents: Submit evidence to show accessible area for all cli 164 .081 Client Manual The client Handbook tori regulations. Required Documents: Update client manual ant Submit a copy of the upd 164.075: Termination at review of some of the rthat the BSAS Complaint Line has been poeted in an easily ants. itiTS and (:88 does not indicate fee policy as required to above i submit agplan clients will be Updated with the new version. eted client manual. . 1d Discharge lient charts that Were'reviewed as part of this investigation showed no evidence of discharge summaries In the client records when a client moved from the ATS level of car treatment location. Required Documents: Describe how program clients that are moving to Provide a quality assurar are completed as require 1.64 076: After Care: Based on the review of ti listed as being in charge demonstrate that referral care for the clients. Required Documents: Describe how program at aboVe regulations 1 64.133: Provision of 3 Based on interviews and inappropriate for that ieve to the CSS ievel of care as well transfers to another RCA ill ensure that discharge summaries are completed for all another level of care even if it' is within the same agency. use plan on how program will ensure that discharge summaries . by the above regulations. - Ie referrai spreadsheet it was learned that Wicked Sober was of aftercare for multiple patients and there was no evidence to are being conducted In a manner that ensures a Continuum of II implement referrals in a manner that complies with the srvices (ATS) chart reviews, there was a client admitted in the ATS that was I of care as evidenced the client?s need for private nursing aides. It was reVealed that private nursing aides were hired for a client. R_equired Documents: Demonstrate how progra appropriate for this level at will assess and provide substance abuse treatment that Is of care INVESTIGATION REPORT DCO Response Date: Complete ln?omplete CLOSURE: Latter Sent: E1 Yes - No Date; 1? Date closed: 4107!:2017 I 058: Agnes Lubega DCO information License Flor 0399 Program Name: Recovery Centers of America at Westminster Program Add TESS: 2.701 Renaissance King of Prussia, PA 19MB DEG issue Date: Mar 09 2017 Due Date: Mar 23 203.7 v-w BSAS ,1 'Reg?latlon? LAreasof Non-Complrance -. instructions Corrective Aotlon' PlenI?2.x Mormoni- . ripplicable) 154.044 A review ofstaff supervision notes revealed that there was no documentation nil-an: fru- m-crf'ooclnnolorrwl-h and 1. Provide a plan with a timeline for ail provide supervision win attend a that provide supervision to be trained in training on providing supervision on March 24., ormm-u?iolnn and documentation of will be provided hv RCA - Supervision forms - Onboardingf orientation develo pment for-acute Treatment Services and or Clinical Stabilization Services . (C55) staff. Through interviews, it was identi?ed that staff are not given the proper orientation and training before they can work on their own to take more of clients. training. trainer with biofresume and date of I golfer supervision. Submitthe following: a copy of Corporate and attendance is mandatory for the supervision form to be Used to supervisors. Topics loci ude: 1. Performance document supervision notes, na me of Management: sopemision, dif?cult conversations, coaching and progressive discipline 2. Interviewing skills 3. ManagerTool 3.01. 4. Preparing for and delivering an annual review. The training is 2 hours in duration. {Staff sign-in sheet and bio oftrainer our: be submitted after this training}. trainlng, length of training, tra mer expertise and Sign ln sheet. 2. Describe how program will provide proper on boardingfor all new staff. . 2. The policy on training, orientation, and onboarding' is attaohed and 15 being utilized for new ?_Lemplovees. 154.943 Document review and interview; identified that neither CSS nor ATS hasthe HSAS required staf?ng levels. There Isone case manager that provides services for both C55 and ATS. There are two therapists} counselors that provided services to both ATS and Du ring the investigation, 15 interviews were conducted, not one staff person could identify who the Program Director for'either the ATS orthe C35 was. - Organization charts - Staff schedules (March 2017) - 1. Describe how the program will ensure . 1. Since the time of the BSAS review, the ATS and that both ATS and CBS will comply with 35.53 (:55 programs have hired staff to meet and} or staffing guidelines. The description should exceed required staffing levels. Comprehensive demonstrate how comprehensive substance . treatment serviceaare ?being provided at 'hoth'le'vels abuse treatrne or services will be rovided of care. Contingency plans to manage staf? ng until both programs are at full staff capacity. shortfalls are in place to ensure that staf?ng levels are met arail times. - 2. Submit a program organization chartfor . both ATS and Also provide a staff 2. An organizational chart and staff schedule for sched ule for all shifts for the month of . Ma nah 2017 are attached for both levels of ca re. March 2017 for both the ATS and C53. Information has been distributed to staff to ensure that there is cla ritv on personnel. 164.083 Based on record review, it was identi?ed that group notes are not consistently being documented and that groUps are not occurring according to the group schedule provided to the InveStigatora. Some or the grduo notes that the investigators reviewed did not provide the reop?rad information abo utthe group 1. Submit a a time-line to retrain allstaff In both ATS and (:55 on documentation of progress notes and group notes. Also submit the following:norm-sole trail-ring, trainer with bio/resume and date of length oftraining, trainer expertise and sign in sheet. 3.. A plan for retaining on the topics is attached and includes the name of training. trainer and bio, date of training, length of training, and trainer expertise. [Retraining will be completed by April 9, 2017 and sign-in sheets can he submitted afterthis training)! Eta?training plans .. Relies training information 2. Staffhave completed the course for these topics through an on-IIne provider (Relies). session and progress of client. For example, some group notes did not identify group topic and client? 5 participathn in the group. Duringthe investigation, interviewees stated that they have had to request and also wait to meet with a therapist because the program does not have enough sta??. Of the 5 charts that Were reviewed, the documentation was mostly based on clients? engagement and oar?dpation in groups and not individual th eraoy. 2. Submit a plan with timeline how STD, Viral Hepatitis, DS and Overdose Prevention education will be integrated into the ATS and C55 programs. The plan needs to include how staffle be educated on the topics In order to provide the education to- ciients. in addition, submit documentation that entails: name of training, trainer with blofreoume and date of training, length of training, trainer expertise and sign in sheet. ?dditional training is being planned to ensurefull . competency in these areas. Additional training will be provided by May 1, 201?. We can submit the name of training, trainer hiofresur'ne and date of training, length of training, trainer expertise and Sign in shoot some conclusion of that additional training. There was also no documentation of Vlral Hepatitis, HIVIAIDS education, overdose prevention as required by the above regulationsfor either ATS or CSS. 154.074 Through docu ment review and intennews, it was veri?ed that a male and female C53 clients engaged in sex in no of the bedrooms; which demonstrates a lack of oversight that ensures the health and safety of clients in the program. .. Case management. ind ividuai counseling and group are not escorting, There Is one case manager that provides services to both ATS and (:55 clients end 2 therapists that provide counseling and group to both the ATS and ATS and CSSare individual programs with separate-licenses. Staff cannot be providing substance abuse treatment servicesto both programs . during doe same shift. Substance abuse therapies, counseling and education which conform to accepted standards of care are not occurring on 3 regular basis in either ATS or CSS. 1. Create 2 quality assurance plan to ensure the health and safety of all clients and staff. The plans need to include how the program will prevent future incidents like sexual contact beboeen clients. 2. a plan that identi?es and analog thatsuhstance abuse therapies, counseling and educatio which to nform to accepted . standards ofcare are occurring on a regular basis in ATS or CSS program. 3.. A process has been implemented to ensure consistent monitoring of the to ensure health and safety. This has been in place and is working effectively. 2. Monitoring processes for clinical elenrents have been implemented under the direction of the Clinical Director. These processes include chart reviews, group assessment, supervision, and regulatory compliance reviews. ., 3.64.302 Document review identi?ed that the program is not conducting a review of the client's prescription monitoring program as required. 1. Submit a plan to ensure that a Prescription Monitoring Program review 15 completed for each client for each admission before initiating treatment of opioid dependence with ogonist or partial agonist ed' Ications. 1. The Director of Nursing and Nursing Case Manager have been provided access to the PMP program and a review is done for each admission. - - Corporate Pl plan - Clinial monltoring plan 164.073 In reviewing client records it was identified that some individual treatment plans are not being signed off as required' in above regulation. 1. Provide atfinnation that treatment plans will be signed by all required participants. 2. Submit a plan to ensure all treatment plans are being reviewed and signed. 1. Treatment plans are being signed by all clients. 2. The monitoring recess for clinical element: includes compliance checks for treatment plan renew and signature. ~Affirmation - Clinical monitoring plan 164.070 it was identified that client charts for ATS and CBS had no information or do?urn entation about the range of treatment options including Medication Assisted Treatment (MAT), the risk a nd benefits oF MAT and the risk and benefits of not receiving MAT. Staff members are not creating conversetio nswith clients around MAT options. 1. Suhmita pianto retrain all staffer: Medication Assistance'i'reatment and submit the. following documentation: name? of training, trainer with hicfresume and date of training, length oftrainlng, trainer expertise and sign in sheet. 2. Sub [nit a plan to ensure that clients will receive the information as required in above 1. Staff receive training on MAT as part otthe' onboarding process through Relies, an online training are new and have not? been through this process will complete this module by April 9 2017. 2. MAT lnfonnatlon has been added to the client handbook and is also provided during group sessions. - MAT training material - MAT group curriculum Client handbook Sample denial log The program?s denial log did not indicate any information on referrals made for that had been denied admission Into the program. For example, there was a pregnant client who was denied admission with no supporting information as to why that client was not appropriate for the level of ca re, nor was - there evidence that any referrals had been provided to the client. 3. Describe how program will comply with regulation 164.070 (E). 3. The admissions department is tracking denials and this infohnatlon is available and reviewed by senior leadership. 154.079 During program tour and document review it was identi?ed or at the SEAS complaint line was not posted In either the ATS or the C55. 1. Submit evidence to Show that the BSAS Complaint Line has been posted In an easily accessible area for all clients. 1. Postings are in place. Picture of posting on units ?154. 031 The client Handbook for ATS and C55 does not indicate fee policy as required in above regulations. 1. Update client manual andsubmit a plan on how clients? will be updated with the new version. 2. Submit a copy of the updated client manual. 1. Client handbook has been updated to include fee information. - Client handbook 164.0 75 A review ofsome ofthe client charts that were reviewed as part of this investigation showed no evidence of discharge summaries in the client records when a client moved from the ATS level of care to - - the (255 level of care as well transfers to another RCA treatment location. 1. Describe how program will ensure that discharge summer rles are completed for all clients that are moving to another level of care even ifit is within the some agency. 2. Provide a quality assurance plan on new program will ensure that discharge summaries are completed as required by the above regulations. 3.. An electronic health record is used to maintain - client charts, Including summaries related to discharge from one level of care to the next. Our treatment teams are required toiustifv the next level of care to which a patient is referred using ASAM criteria. When a client completes a detox protocol on ATS, the therapist is required to summarize the from this level ofcare in an ASAM Dimension Assessment note wherein they simultaneome document the instillation forthe recommended fol llow up level of care. such as C55. the ASAM Dimension Assessment, the discharge plan. information about client diagnosis, - Clinioal monitoring plan pm u-m? a u- u- and ongoing risitfactors are also included. In order. to ensure this standarn? is met in accordance with the regulation, the {Program} Director and Case Management Director are responsible for completing full chart reviews of ail discharged . - clients within 2 days of discha rge. Should the documentation not be In the chart, both the Clinical Director and Case Management Director wili instruct the therapist to complete said documentation and wiil complete; 11 additional chart 24hours. 2. This is Included in the clinical monitoring pla n; 154.075 Based on the review of the referral - aftercare for multiple patient and there ?mumm? Sober was listed as being In charge of Was no evidence to demonstrate that referrals are being cond titted in a manner that ensures a continuum of care forthe clients. 1. Describe how program will impiem above regulatio ns? 1? Comprehensive aftermre planning is provided by . the clinical staff. Contirg?ng care plans and - Continuing care poiicy I . . ., - .no. discharge pie ns include information that compliant with BSAS regulations. - Increased auditing of the quality.r and content of these plans has been put into place to ensure organizational and regulator,r standards are met. 1.64.3133 Eased on Interviews and chart reviews, there was a client admitted to the (:53 that was inappropriate for that level of care as evidenced the client?s need for private nursing aides. It was revealed that private nursing slides were hired for a client. n5: 1. Demonstrate how program will assess and provide substance abuse treatment that is appropriate for this level of care. 1. The programs will follow eligibility and admissions criteria. This will be monitored through the clinical monitoring plan and routine chart reviews. Admissions} eligibility criteria . .v?uu . .n?m -- Recovery Cancers 0f Maritza One-on -One Supervision Meeting Employee: Supervisor: I Date: I Time: Topics Discussed bet-ails . Plan ofActlon,Timelmef,? [Followup Page 1 of 2 Additional Topics or E-- Recovery (36:11:ch 621? America . 2. 3. Comments: . Employee?s Signature: Supervisor's Signature: Next Meeting Date: CC: Personnel File Page 2 of}? A '1me 4 R+3covery Centers of America . Supervise-e: DATE: Supervisor; [1mm Cm Update! AsdonPinT: Mons f9; Snge?isee: . A Staff Signature Supervisor Sign amre 2701 Renaissance Bivd., 11?? Floor, King of Prussia, PA 19408 DE- EI. - Recovery Centers Qi?Amcrica Title: Employee (Bria ntat Effective Date: August 2016 Manual: Human Resources Related Dcpertment(s): All PURPOSE: To provide comprehensive ion and Dngoing herring Policy Na: 3016 Reviewillevision Date: Page 1 of 3 consistent and compliant-orientationis) and training(e} to individuals employed by Recovery Centers of America (RCA) To ensure that all newly hired staff are thoroughly oriented to the facilities and irocedures of RCA. To ensure that all newly hired staff so mplete trainings that are required upon hire. To ensure that all those employed by RCA complete trainings that are required annually. POLICY: RCA utiilies a combination If oaline learning manageme live trainings instructed by RCA staff and content provided by an system to train its employees. This policy details tra speci?c to our enilne learning manage neat system. Certain trainings are required strictly upon hire. Certain trainings are required to he completed annuaiiy. -. PROCEDURES: A. Trainings to be com plete upon hire: RCA enrolls ail hewly hired employees-in the list of trainings detailed below. Trainings are provided by our onlirre learning mane gemerrt- system. Trainings are required to be completed within 90 days of new hire orientation. 1. Parity Laws 2. Discrimination in the rkpiace 3. . The 12 Steps 4. dvewiew Of Substance {glee Disorders Part II. and Pa rt 2 5. Dragsin'the Workplace 6. Workpiaoe Harassment 7. Fire Safety 8. infection Control 9. Confidentiality of Substance Use Treatment'lnformation 10. Dcescaiating Hostile Cl ants . 11. Corporate Compliance and Ethics 5-. Ql'Amcrioa Title: Employee Orient Effective Date: August 20], Manual: Hmnen Rosomoee Related Bepartxiten?s): PL -- etion and Ongoing Training Policy No: 3016 6 - . ReviewfRevision Date: 212017 Page 2 of 3 A 1 12.0iient/Patient Rights 13.0uiturai Diversity . 14.2HIPM and Behavioral 15.Medlcetionessisted Tre saith- atment in Opioid Addiction B. Trainings to be completed upon hire and annually thereafter: RCA enrolls all employees provided by our oniioe learn 90 days of new hire oriente Fire Safety in?eotidn Control . Con?dentiality of Suhsta Corporate Complienoe a Client/Patient Rights Cultural Diversity . - HIPAA and Behavioral Elle-escalating Hostile Cl Active Shooter 10.3ubstanoeiJse in the Fe separuesneepb. (2. Additional Trainings to patient-facing treetmeni RCA enrolls all newly hired Joy our onli'oe learning men: of new hire orientation. 1. Coloccurring Disorders 2. introduotion to Trauma hformed Care in the annually recurring list of trainings detailed below Trainings are pg management System. raininge are required to be completed 3) within :ion and 7b) an nueliy by the end of each calendar year. one Use Treatment information lid Ethios . eaith eats mily - MA Only' completed upon hire forell staff employed at an RCA Contact Center or center: employees in the list of trainings detailed below. Trainings are provided 1gement system. Trainings are required to be completed within 90 days . m. . .- I Recovery, Centers qi?dmerica Title: Employee Orientzfon? and Ongoing Traieing Policy Na: 3016 E?ec?ve Date: August 201 Manual: Human Resources Related Deperimen?s): All 4. Preventing Slips, Tries a ReviewlRevision Date: 2/2017 Page 3 of 3 3- Recognizing and Respoaning in Abuse Falls 5. Suicide Assessment and freetment - 6. Bleed?borne Pathogens? D. Additional Trainings to an RCA Contact Center 0 completed upon hire and annually thereafter for all staff employed at patientufa sing treatment center: . RCA enrolls all employees i i the annually recurring list of trainings detailed below Trainings are provided by our online learning menegement system. Trainings are required to be completed a) within . 90 days of new hire orientatlen and b) annuelly by the end of each calendar year. 7 1. PreventingSlips',Trips ard'Fells 2. Suicide Assessment and Treatment 3. Blood-borne Pathogens 4. Workplace Harassment . Recovery Centers of America WestminSter Facility . - - Organizational Chart Direcmr of Wetter 0f Citinicai" D'r -r - Direcror of Case ?New nclmissiuns - Services emca {al.o-r Managmant Manager Admissio? -. - - . C?ordinalors - I - . . NU?I?scil?mc 3 Case Managers. UR Coordinamrs Lice-meats Practical Nurses Suppori I. Specialists ic?! P'rbuid?r?; Medical Agsistalnts . Clinic's! 'Coo'rcu'aat Effective: Sept. 2015 Revised: March 201?} a uh Recovery Canters of America Westminstef Facility Organizational Chart - Director of Nursing Nurses Effacthre: Sept. 201.5 Revised: March 2017 . .. ?an. .. . . Registered Nurses Licensed Practice} ,f [Medical Agsista Director of Admissions Admission Coordinators - irector of Case . Managmeni Case Managers Utilization Review Manager UR Coordinators and Viral Relias Online Training (1 An additional level of tr designated Ct implementation will lac Recovery Centers 0f America. .RC EA Training-Wan Hepatitis is provided during the {in?boarding process for all staff or; nurses (see attached outline). aining wilibo given to our Nurse {I'ase Manager who is RCA Westminstel?s ordinator. ludd one group per week in both the CSS and ATS unit. Documentation will . he done on each patient in individual progressno?ces. Overdose Pr?veot?ion to include Narcan Train documented in the EM We are we rkirlg with 01 including AIDS Project of training to both stafl ill be done weekly by our ,Ciinical Coordinator in both the ATS and (:55 unit, Eng. Additional training will be done with individual patients as needed and i. individual Progress Mateo. I her companies that pfovide and Viral Hepatitis training Vor?cester and Thel Canter for Social innovation to provide an additional level and patients. 270 . Renaissance Blvd, Floor, King of Prussia, PA 19405 This worse provides basic works and doesn?twork with Hm will also diecuss testing For the has no relevant ?ne nciai or non Course Ou?ine. Section 1: Introduction -- A. About 11115 Course - E. Learning Objectives - C. OSHA Requirement 'Seetion 2: amass Overvidw A. Meet: Mary C. HIV Progression D. AIDS Progression E. Mary; What Went Wrong F. Review G. Summary alien on HIV and AIDS. We will define HIV and AIDS, how the immune system and AIDS. We wilt discuss how HIV can and cannot be transmitted. The course virus and heal-merit for the infection. Disclosures: Nancy Luge APRN, ancial relationships to disclose? . B. What is What is AI Seation 3: How is HIV transmitted? A. Fluids of Transmission B. Transmission of HIV D. Standard Precautions E. Additional Precautions F. Poet?exmsure Prophylairi G. Prevention Overview I. Prevention Strategies: U.: PreVention Stategies: 5 M. Review N. Summary .iltllii??i't??l Section 4: HIV Patterns A. HIV Across the globe How HIV Is NOT Transmitted H. Prevention Strategies: Ftotection during Sex ing a Male Condom . ing aFemale Condom - Strategla: Barriers during Oral Sex L. Prevention Strategies: Cioice of SexuaiPartners How Common Are HIV enci- AIDS in the United Slates? C. HIV Patterns D. Age E. Gender and Sexual Behaviors F. Muitiple partners H. Race and Ethnicity I. Perception 3. Knowledge Is Power K. How Main}! People Areltrecxed and Do we Know It? L. What Should You Do if Exposed to the Virus? M. Review Summary 2705 i I a G. Intravenous Drug Users it Renaissanoe Blvd, Floor, King of Prussia; PA 19406 Section 5: Testing A. Who Should Get Tested? 8. Types of Tests - C. Continuing and Diagnosir Tests Interpreting Results- Where Can Someone Get an l-iIVTest? Home Tests (3. Con?dentiality, H. Reporting Requirements 1. Con?dentiality - J. Post-Test Counseling K. . . L. Summary - . Section 6: Living one: HIVIMDS A Treatment B. Stigma and Prejudioe - C. Review D. Meet Jeff E.. Living With and Managing HIV . F. Starting Out Healthy . Stemming Weight Loss: on the Calories! H. Stay Hydrated I. Keep Food Invaders Out 3. What about Sex? K. More about Sex and Finances- M. Review N. Summary nootooit'tqouco Section 7: Condnsion . A. Course Summon! . B. Resources In C. References Learning Objectives - - De?ne HIV. De?ne AIDS. Describe the role of the immune system. Describe ways that HIV can be transmitted Identify two recommendations lor HIV testing. Explain the difference between a screening test and con?rmatory test for HIV Desmbe the Em padt of anti-retroviral therapy on the disease course Information -. . . . Slammer . Nancy Logo, DrPi-i, APRN - Dr. Logo, 3 famin nurse practitioner and public health emert, has provided came to thousands of individuals and families. She has developed community based HIV testing programs, community health worker programs, and progzar'ns for people with AIDS. She has shared her expertise through. universityr teaching, workplace health coaching, and numerous peer?navlewed pubiin?ons. Disclosure: Nancy Luge, has dedered that no con?ict of interest, Relevant ?nancial Relationship or Relevant Non-Financial Rela?orship exists. Target . The target audience for this course is: advanced level General Staff; entry level Alcohol and Drug Counselors; 2761 Renaissance and, 4m Fioor, longer Prussia, PA 19405 . . . entry level Nurses; entry level Language Pathologists; in the fol Relies Learniog has a grievance every effort to resotve each grievr wing settings: All Healthcare Settings. Hay in place to facllitate reports of diosa?sfac?on. Relies; Learning will make moo in a mutually satisfactory manner. In order to report a complaint or rtitfemional Counselozo; entry level Sodal?Workers; entry. level Speech and I - . Fl grievance please contact Relies morning at sopport?reliaslea mingxom. If you require special accommode dons to complete this module, please contactRellas Learning Customer" - Support (890) 3?l~232l or entailing All courses offered by Relies Looming, LLC are developed from a tonndatlon inclusiveness, and a multicultural perspective?nowlo alga, values and awareness related to cultural competency are infused . ?tmugh'out the course content. . To edrnoon?nuir?eg education crellt for this course you must: athieve a pa and oomplete the course evaluao on. 270 ssing soore of 80% on the post~test E1 Renalssanoe Blvd, Floor, King of Prussla, PA 19406 . - 0.5m Wit-1.3.9 3333112191 numb nmmwimt . prawn Mam 13mm mm} Pathdigens Hum?Hm .. [?Wd'uadIand'mvanpbm mm mints-in amend adrirmm, ?warm fumnrdin mama-fame p'a?gm Fatima WEWW a EMIIWWISU . cmaaqmm- Whammy-tumult . ampmm . Amhm? 4 EWPW a Qm? In a ?91?an II EVami-ia?uu . QW . - Mom-up mam-dam km? *8..me GRESSUW . - Emmott; .CanImmn?mquVkunim a It, Medial WW and-Tram ant .. mun-wu- Flint Barn: Wumdng HEP. Hmw?u?e?rt?m pf mrmam Imw haw In manna :1in mam nasal-2., mp, cm man, as?. am wear a mnmpumrt, ?nishes; may manan m?hsafaiy, whichaalth, prelim - mum Wrapmpam?: . -. ummi?m mmnamm ##th mm Mfu- and ms'em mm!- w.m?mab?mm?tau1ymrsufl D. "Mm: Wiv?m: madam, mm: mm?: .. -- atmulzc?ml, WE, manhunt! putty a1 ievets ??mtm mm Fadarai}. fi?ht?sa MmofPquM Unm,0xmm?s?wmm- - .. -- Haaith 01'th - mm, Wilma! hagstmoe'?am, Wand-1: Chan; 3 .. laudetsmaund armemed?m Red - - -- '1 (hm: minimum: M?nuy Harms, Hm? PHI, mama mmaamn?mnt?u - 3mm Mum-am . tn Mina: Rdlas Inu?crmreporta at summh?lgm Ifwu mm 33:13:!me - pm my: meme, mama: Re?a: 3811232iorafnaifn? Washinhgm Tom mmingedudm mm . - muse. 5w mum-am a Mascara owner. nation. . .. pun-pm oJl .- Title: Performance Improvem ant Plan Policy No: 8000 Effective Date: June 2018 Review/Revision Date: Page 1 of 7 Manual: Performance In: prove 11th Related Deper?nen?s}: All I 1. . PURFOSE: The purpose of the Performance Governing Body, medical staff processes and mechanisms that. dress these values. The following sections define the protocol for this - measure assess and Improve pe omlenoe offacility wide key functions and processes relative to patient care. To- achieve the primary goal the pi strives to: A. Incorporate quality pl ing throughout the facility; Provide 3 Systematic n1 hemism for the facilitys appropriate individuals, departments and professions to function collaborativel in their efforts toward performance C. 1 Focus open what 15 pc care. To facilitate this performance include: rocedurc or treatment in relation to the patients condition; of a speci?c test, procedure or service to meet the patients needs; needed test, procedure, treatmentor service to thepa?cnt who needs it, E?icacy of the Appropriations Availability of Timeliness wi Effectiveness in th which tests, procedures scannent and services are provided; providers and ver time; Safety of the pa tient (and others) to whom the services are provided; Efficiency with which services are provided; . Respect and co .iog with which services are provided I. D. I Provide for a program that assures the designs processes (?so special emphasis on design ofnew or revasn 311s in established services) wail and systematically measures, assesses and hnproves its performer: cc to achieve optimal patient health outcomes in a collaborative, cross~ departmental, ioterdisc focus elements: 0 Consistency 'w th the organization?s mission, vision, vaIues goals and objectives, and plans; Meets the need 5' of individuals served ste?' and others; I Use of clinical sound anti current data sources (for instance, use {if-practice guidelines, information from relevant literature and clinical standards); mprovement Plan at Recovery Centers of America (RCA) is to ensure that the :1 professional service sta?' demonstrate a consistent endeavor to deliver care that is optimal in an environmen of minimal risk. In keeping with RCA mission the Performance Improvement Plan allows for a systematic, co dineteci and continuous approach to improving performance focusing upon the med throughout the facility, and how well it is performed to provide health 11}; emphasis is placed upon "diluensions of performance". These dimensions of . which a needed test, procedure, treatment or service is provided to the-patient; Continuity oft] LB services provided to the patient with respect to other services, practitioners, plinaty approach. These processes include mechanisms to assess the needs and expectations ofthe pen cuts and their families, ste? and others. Process design contains the following [Ell 44E. Rewvew?tnee atomic: Titie: Perfonnance Improvem nt Plan Policy No: 8000 E?ectiVe Date: June 2016 Review/Revision Date: Page 2 of 7 Manual: Perfonhanoe immove out Related Departrnen?e): All Ill,- 13 based upon so :1 business practices; I Incorpore'tes eve able information from internal sources and other organizations about the occurrence of :11 'cal errors and sentioel events to reduce the risk of similar events in this institution; . Assure that the improve out process is organization?wide, monitoring, assessing and-evaluating the quality and appropriateo of patient care, patient safety practices and clinical performenceto resolve identi?ed problems and prove performance. Appropn' ate reporting of iofomiation to the Governing Body to provide the lead 1'3 with the information needed to ?li?il its responsibility for the quality of patient care and safety is required mandate oftbis plan. - Assure that necessary relation is cominunioated among departmentefservices when problems or opportunities to itnprove etiont care ioVolve more than one department/service; and that information ?rom 3 one the ?ndings of discrete performance improvement activities are used to detect trends, patterns 0 erformance or pote??al problems that affect more than one departmentfservice Identify important key a to of care for the health and safety of patients. Included are those that occur frequently or effect larg numbers of patients; piece patients at risk of serious consequences of deprivation ofsubstanti bene?t if care is not provided correctly or not provided when indicated; or care provided is not iodicate or those tending to produce problems for patients, their families or staff. IEADERSHIP: . The mic of leadership is paramount bnporteece in the perfonoencc improvement process. This responsibility is accomp ishodio a number of ways following several key processes: Adopting 9. Po ?nance Improvement Approach . Setting Priorities and Allocating resources for assessment and improtremeot activities Managing, Le 11g anti Participating in P1 activities - an Leading a Process for Review of Signi?cant and Untoward events and Sentinel Events -- Assessing the ectiveoeos of the PI program including Leadershipe? role - Assuring that pmvemente are sustained overtime Approach: The leaders establish a planned, systematic, organiZation-wide approach to process design and performance 'meas?urem bt,? analysis, and iroprcvemont. Performance activities are most e?'ective When they are loaned, systematic, and orgaoizetionnwide and approp?ate individuals and professions work oollab ratively to plan and itnplement them. . - 1.. Quality Service emont: The leadership at RCA has embrace! the?principies of Quality Service Mongemeot: . . Every empl yee action impacts customer satisfaction - Quality sort icemust be stated in speci?c behavioral terms to ensure its delivezy I An individual service?rotated concern within one area of the facility must be rede?ned as a a concern - Customer si?sfaetioo and ctopioyee satisfaction are inseparable Everyone in the facility must be held accountabie for constant and certain quality customer somee . . - . II El. Recovery Games '?tle: Performance Improve nt Plan - . 8000 . EffectWe Date:.l11ne 2016 RevIeW/Revislonpato: Manual: Performance Improve out Page 3 of 7 Related Depamhen?e): All I The facility must receive objective feedback ??om its external-11nd internal customers a Success is d: tennioed by the satisfaction levels of customers ?p at RCA has selected the PDCA approach to portemmoce ?tiprovement. improVement and lessons learned g, adjusting or abandoning the change improvement. including . Eviden and ?ndings from the national and local health care community; . 2. Emergi best and evidencebascd practices; 31 Data fr ite own experience over the last year and major issues and prolaleme encoun d; 4 Digs on, perspective and insight from leadership and front line support and clinical 5. Results 111 the 11111111211 summaries of key areas of perfonnauee such as quality mom'tors,? infeoti control, human resources; and, 6; Enter mandates ?om local, state and federal govermnents and law organization uses appropriate resources and involves those individuals, I). Allocating Resources: . ents closest to the process function, or service identi?ed for?iotproyoment. disciplinee, and do B. Leading; Managing and Participating 111 P1 Activities: The leaders set expectations, develop plans, and manage processes to as ess improve, and maintain the quality of the organization?s gooemaoee, management, clinical, and support activities. These may include activities such as: - The sta??s authorities and responsibilities are stated 11:1 writing and include 1g and acting on reports and recommendations clinical staff eomn?ttees progrm es, and services, when applicable I Profess .ionai and administrative sla??s monitor and evaluate clinical perfonnence and the quality of care provided to individuals served, resolve identi?ed problems, and report a?on to the getteming body to help it ful?ll its responsibility for the quality of care for in viduals served. of pa rmanee improvement. This requires establishing clear cemmunieation processes and igoing amounte?ility for foliow?tlnough Leaders set the tone for participation in interd ciplln?ry perfounaoee improvement activities by participating 111 such activities Ell rem Ronni-Centers demerits Title: Performance lmprovem nt Plan Pulley No: 8900 Effective Detention 2016 Reviewf?evrsicn Date: Manual: Performance improve ant Page 4 of 7 - Related Deportmen?esome ?ll, coordinated performance improvement process depends on oomfnunieating its cone] eions and recommendations to individuals responsible for carrying dot and irnprovements. IS established for speci?c improvements to motivate their implementation To do this, lenders also need relevant information ?'orn performance improvement activities - For proc :35 and procedure irnprovements to be done success?rliy, accountabili?es must be de?n and followup notion taken Sentinel Events: leaders ensure that the processes for idnotifyingr and managing sentinel events are defined and implement . Assessing E??eotiveness Elie leaders set measurable objectives for their work to improve organization performance; gather inf etion to assess their e?'ec?veness' 111 improving performance; use pre- eetablished, objectiVe eess criteria to analyze and assess their e??ecliveness; draw conclusions about their eontribntion to per nuance improvement; develop and hnplerneni improvements or their activities; and evaluate the e??eeti tags of mprovements to their activities - Assuring anmvements Sustained Over Time: E?'eotive changes are incorporated into standard operating procedure. organization sustains improvement through education of key eon" about the new procession); or red igned processlie's) or other changes being implemented. Baseline data is - collected and perfo measures are used to determine if the improvement is mistained. Data are collected as part of perf on monitoring. Feedback is provided to staff and leaders on a regular basis. The organization also noes the risk of sentinel events by using available information about sentinel events known to occur ith signi?cant ?equenoy in health care organizations that provide similar core and services. This is 13 so that the organization oandesign or redesign care and services to prevent the event from occurring in to organization. score or ACT The scope of the Perfo once Improvement Plan includes no overall assessment of the e?loaoy of. performance improvem nt activities with a focus on continually improving care provided throughdut RCA. CollaboratEVe an speci?c indicators of both key processes and outcomes ofcore are designed, measured and assessed 3* all appropriate and disciplines of the facility in an effort to improve organizatio performance. These indicators are objective, measurable, based on current knowledge and experie co and are structured to produce statistically valid performance measures of care provided. This men 5111 also provides for evaluation of improvements and the stability of the improvement over time - i . A. interdisciplinary Cdmmittees: 1. Special Review Teams: Interdisciplinary Teams may be molded by the Performance . Improvement (3 ommittee to foeus on particular problems or processes, plan for change, measure the e?'eoi: of on mge, assess the result and improve performance offaeility?wide key ?lnotions and processes. The 33 teams will be developed on an ad hoe basis and will report to the Performance Improvement enmitiee and, through the PI Committee, to'the Governmg Board. Teams on: be interdisciplinary in nature, comprised of deparhnent supervisors, medical staff as needed and . . [Ell El Recent Centers alimcrio Title: Performenoe Improve nt'Plan . Policy No: 806,0 Effective Dete?uoe 2016 . Review/Revision Date; Manual: Performance Improve neat Pages of 7 Related Bepartmen?s): All those individualt de?igoated from each depamaent, as appropriate, who may have the highest . - Mordtoring or Facility?wide Monitors, both internal and ememal quality monitors shall be used degree ofknowll xige regarding a given topio. Departmental uttering; Each clinical department or service in the facility will doVolop a plan for ongoing it)! monitoring and poxforrnanoe improvement, relative to the types of services 'provided. Such inns will include standards for perfonnanee and evaluation procedures designed to satie?' the ob otives stated in this Policy. Reports of all clinical serviceawiil be made to the. Perfonnanoe rovement Committee on a quarterly basis. The dimensions of performanoe of patient care on utility assessment and improvement activities in the following services are monitored, ass sod and evaluated: - a Nursing Services I Clinical Services I 0 Medical Services - - - Phannaoeu?oal Services -- - I . - a. In addi on, nonelinical departments will establish patient anti/or staff satisfaction goals for pe rmnnoe improvement. Reports on all patieotfstaff satisfaction activities Will be submi tome Performance Improvement Committee on at least Bil annual baSis. Facility-Wide atisfaotion Surveys: The Governing Body has established mechanisms to assess the needs and (peoiatione of patients and their families, staff and others. The following Facility? ?Wide Surveys: to conducted and reported to the Performance Improvement Committee, which analyzes the data and identifies Opportunities to improve ?aervioo performance and presents this data to the Gov naming Board: - . II Patient Survey; - I Referral Source Sufvey; - Employee Survey . In out the Performance Improvement Plan, the Perfonnanee Improvement Committee will seek to assure that assessment of the perfonnanee of the following patient care and - organizational Eimotions areineluded; . Patient Rights?and Organizational Ethics Assessment of Patients Education of Patients and Family Care of Patients Continuum of Care Leadership Infection Control Utilization Management SafetyiRisk Management . Human Resources Care of the Environment Management of Infoma?on Quality Monikrs: In earning out the work of the Specie! Review Teams, Department IE. 2: Romeo (lentils dismiss We: Performance: improvement Plan . Policy No: 8000 Effective Date: Juno 20.16 Review/Howlerorr Date: . - . Page 6 of 7 Manual: Porfomanco Improv ment Related Dopartmonqs):mi . to assist in ovaiiating thoquolity, appropriatoness and oft?oc?voness of the Care provided. All . rformaooe improvement aotivitios shall be? based u?bn committee, add facility?wide po such internal an . be included mean}; annual addressed in the: mus! plan. external' quality monitors, and those internal and th?l'??i quality monitors shall play. When issues are raised by the quality monitors, those shall ho - 1. Into: moi Quality Monitors: types of internal quality monitors include: Chart Audits Medication ?rror surveys Patient fall surveys Potiontinjuryiinoidont rates . . g. AMA rates . . - Facility Acquired Infection Rates 2. Ex lama! Monitors: typos" ofextomal quality mom'tozjs include: - Feedback from Reform] Sources on pationt continuing oaro plans Potion: Satisfaction Survey National Norms Reports provided by Payers Smoys provided by regulatory bodies and accrediting agencies I?ll, 3. Dewolopmoot of an Annual Quality l?lan: Each year, a Performanoo Iroprovomont pl Lo shall be developed which monitors the quality, approp?atonoss and effectiveness mime cane provided and which addresses issues raised by the quality monitors. Bach Ini ordisoiplinaty Committee and Department will submit an annual PI Plan to tho ifonnanco Improvement Como?tteo for its review. ?Iihoso individual plans will be omitted to ?le Governing Body for its review and approval. In addition, the warning Body will develop Facility~Wido Performanoo Standards each year. The i ?Wide: Standards, plus the individual plans oftho Interdisciplinary mmittoos and Dopamnents shall oonstituto Performance fo thatyoar. Po so v. ORGANIZATIO s; Psorocox. moms QUALITS: A. The Imoj ovomeot Committee has boon established by the facility: 1. To ovorso a tho o?'octivooess of the Facilityzs Posfonoanqo anrovom'cnt Plan, including monitorin ovaluo?og, and prohlom~solving activities; To sonic: as the designated coordiootitig moohonis?m for all Facility-Wide, hitordisoiplinazy, and ?1er mental porfonoanco improvement activities; and To report hooded infonna?oo to the Governing Body 1:0 assist them in ful?lling thoir responsibilities for the quality of patient care. I too] e- . Roomy Ccmcoc?matim Title: ?erformanoo Improve out Plan Policy No:8000 Review/Revision Date: Effective Date: June 2016 Manual: Performance improv moot Related. Deoartmen?e): All . Pago'Zof?? ement Committee is muI?-disoiplinaty in its scope and membership. of, mmitteo will include, at a minimum, the CEO, Medicai Director, Director?of r, Infection Proventionist, and Quality Assurance Manager, HIM Coordinator, 11d Risk Manager. -, B, The Porformahoo Impr Repmsontati on on the Nursing, Clinical Diroc Director of Operations, i oment Comittoo will: quarterly or as needed to review data remitted ?om performance ?nprovemeot' activity in regress at the departmental, interdisciplinary or facilitymide levels. 2. Ovemee _m altering, evalttotioo and improvement activities, assuring that important oopeots 5.5. of patient and clinical performance are rovichd, providing assistance: where needed. arts on Such-activities. 3. Analyze so :11 material in terms of overall impact on the facility, integrate information, and detect iron: 3, patterns of performance and potential problems that might affect more than one . department. 4. Transmit it formation to department supervisors when problems or opporhmities to improve care involve more than one deptf; track the status of efforts to resolve problems or improve care. 5 . Maintain documentation concerning all performance improVement ?ndings, oonolusions, reoommomla?oos, actions and results of actions. 6. Report role vaot ?ndings from all performance hnprovement activities perfonnod throughout the instimt on to the Govomiog Body on a quarterly basis. 7; Select rmance measures inoomplianoe with all local, state, and Federal requirements. 8. Evaluate e??eotiveoess of the Perfonnauoe Improvement Plan at least axmuallji and noise it as ary. - A .. Recovery Of America- reatment plans be signed by all required participanfs. Compliance This serves thatl ed through the clinical manltoring plan. this requirement will he review} 5513 Date 27K 1 RenalSsance Blvd, Floor, King of ansla, PA 194 06 mun?s . . Rootivory Centers Of America Clinic allCese Management Monitoring Plan?Westminster Monitoring processes for clinical elements have been implemented Under the direction of the - Clinical Director. These processes include chart reviews, group assessment, supervision, and regulatory compliance re views as detailed below I Group and/or incl vidual supervision will be provided to all Recovery Specialists, Case Managers and nicai staff a minimum of The Clinical Director will provide supervision to th Rescuery Specialist Supervisor and Clinical Supervisor. The Birector of- Case Menageme will provide Group and/or individual supervision to Case Managers. See attached su wlsion log and clinical. supervision note. - The requiremen for clinical and case management services and decumentatioh will be reviewed with a} clinical and case management staff in group and individual supervision See ttached RCA Therapy and Case Management Requirements, Necessary Clinical Docume totion outline a The Clinical Dire tor (and'clinical Supervisor, Clinical Coordinator as assigned) will complete ten do chart reviews on a weekly basis. Each week a minimum of 50% of charts will be re iewed, with the results provided to clinicians and discussecl in bi? weekly supervisi n. See the attached RCA CIA audit tool I The Clinical Dire or {and ClinicalSupewisor, Clinicel Coordinator as assign ed) will ensure that gro ps are held consistently, according to the evidence?based group curricula that in lucies: Multimedia 12Lste'p Toolkits, Multimedia Relapse Pretrention Gettin Motivated to Change TCU Toolkit, Unlock Your Thinking FTCU Toolkit. See atte hed R55 Facilitator Auditing Protocol and Supervision Chisel-(lists for groups. Centers 6f America Patient Name: Admit Date: Admission Discharge evaluation comp} 'Ihaatment plan completed Tmahnent plan updaie (fmm admit to) om; Dimension 1:Briofcommont addroa: ing acute ?ltoxioa?dn and/or withdraw potent .al progress or stams Dimension 2: Brief (:0th addreming biomedical conditions and complications prom 53 or status progress or status Dimension 3; Brief common}: adore! sing emotional, behaviorai, or. cognitive conditions md complications change Dimanion 4: Bnef comment on pa ants readiness to Dimension 5: Comment concerningmlapso, cautioned use or oon?nuod problem potential. living environment . Dimension 6: Comment andfon 01311er Total: . Completod on ?me? Mental status ovahxa?on (includes concentration, memory and impul iffoot, speech, mood, mought content, judgement insighia?ention, comm} Proson?ng problems included in to ?8 Plan Signed by therapist Total H. 'W-h . Day completed (within .72 hours of ac mit) Page I: All areas ?lled out (Assessm at time, me?tal status, Race, Ethnicity, Religious ace mmoda?oos) Page 2: A stazoment from client on what do they get from umng. Page 2: All prompts ?lled out on substance use, tobacco Page 2: All areas of abstinence, re se patterns provided by client - Page 2:301 areas ofDT?s and 013?s ?lled out including desenp?on I Page 3: Other compl?siVe ordexs pr: ?lled Out (with description as needed) Page 4: Statement from client about what was help?li in rior treatments Page 4: Prompts filled out complete ly (including descrio?on as needed) Page 5: Prompts ?iled out comple 1y Page 5: Statement from client o'oouL ?nancial burden from alcohol or drug use. I . Page 6 Section 06111131: .66 PXge 7: Biomedieal Conditions soc ion completed Page 8: Safety ?sk screening secti 11 completed Page Employee Section comp! including statements - . Page 10: Legal in?ammation promp'e completed Page 1 I: Liwiog Eo?ronmeotIFam Ely Smaport completed Page 12 Spirihiality section {:6wa eted Page 13: Rema?omisme Time section completed including statement of past activit. es enjoyed Part 14: Has client been in the mi] itazy, ifyes prompts following are completed Page 15: Sexuality section promp oomplemd Page 16:81otemeot of goals for trfza?nemfbarz'iers for treatment Page 16: Client statement. of shoe g?zs to help achieve oaks Page 16: All treannent prompts 6 ?lled out 121 Signed by thekpist and client Total Problem/Individualized problem are based on the mformation from ossesomentfbio sychosooial Treatment pian has objective i observable and measurable goals The goal(s) 15 based on the prob em statement Objectives one measurable and a early state whet the pa?eotw?l do to achieve the go {1119) . I - Intorventiouo ideu??r how the stoft?x Jill assist patient. Frequency, Amount, Duration, and: hidioated for each inmon?on ta?" reopensiblo are Plan identi?eohow goal attainmenti to bcmeaoured Strengihszan'iom identi?ed Quality of troahnent plan is present There is airidouoo that the irea?nont relevant: addresses issues relevant to reiigion, ethnicity, age, gendor, son! of oduoa?oh, min-economic. level. plan is Claim-rally, .tho ontolicc?s ratio, a} orientation, love! prresonted, issues are addressod All signatuies are ?lled in (client? an i therapists) Target dates andlachievod datos are ?lled in as applicable Total TrooynootPianUpci'm .- H?o?wh. 1s at least one Assessment ofo?entprogross: thom' Statement wi??n client progross Soc on that indicates . whether each strategy has who no been completed or remains in progress. Iftho shaggy in progress an explanation ofu?lal the cliont has no thus for is ovidsd. If?lero are new orrovisod teams goals (oompaxo to original 'moatmont plan) they shoul listed under newlrevised treatment goal and 11de mad at the top of the moment plan up date prrocentod with issues it is addraosed the heatm??lan up we All dates and slgoamros are ?lled in client) (thempists and Total ?an Audit Date: Addito r: CM: Therapist: pr Rcc?very Centers Of America Supemisee: Supervisor: Attitude, safgty El Team Apprn?m ?mamas 0f . and [3 Attendance and Punctuallry '13 Time Managefnent Care meassionai Growth and [3 RCA Mission, Vision, and Vaiues Prafessluna! Standards (boundaries, ethics etcngress Notes: Assessments: Treatment Ptans: Supervisee Signature Last Reuisiun: 10f21316 Date: Faclii?w: Mahagement Prunedure nf Assegsment Skill Notes {?aming Response to Start Time: End ?Huge: Ciinltal Outcnmes - Vital-"ES CasaSpect?c Summsgo? No Show Hate Compllancefauallty Review Issues Famlinherapy Group Therapy El Length of Stay El [3 En?h?duai?rherapf Evidence Basal Interventions 8' Patient Experience SuperVision? Log {3 Administmtion [3 Training El .1011 Duties Audit El High Risk case: or concams SupervisorSignature nun-.m? In.? .. . Recovery Comets 0f Ameriea R55 Facilitator Auditing Protocol All audits supervisilm logs, and disciplinary action forms are to be maintained within the employee HR file.- . For ease of reference ehd'centinuity, it is teen ;2 additional ~?le speci?c toeach RSS. .13, b. Rss'Supe Eur/Clinical Coordina: :9 ensure faci tator competency acre c. Quarters: e; at}; each audit utilizing the 4; the spec! seminarfwerkshep to be audited ange Seminar Supervision Checklist miner Series Supervision Checklist 3. Audit Checklists er a to be completed in entirety te include documenti?g audit result of ?yes/no? 4. BSS SuperVisor/Clieical Coordinater is responsihie to ensure adherence to the following Performance In: pr: wement Steps for any audit resulting in a ?no a. Performan ce iianVement Steps: 11.2.16 I. Step (?rst audit resulting' In RSS Supervisor/Clinical Coordinator pro?les supportive strategies and recommendations via 1: 1 coaching to impro Ire audit results. 1 I R55 Supervisor/Clinical Coordinator will audit the same seminar/workshop within one week duration to monitor performance improvement ii. Step ?second audit resulting in R55 Supervisor/Clinical Coordinator will erran go for supportive coachingwith RCA Clinical Training Team i - 1 RSS Supervisor/Clinical Coordinator'tirill audit the some within a one; .wgok?duration to monitor performance improvement . lli. Step 3 (third audit resulting in "no?i?l RSS Sapef?lsor/Ciinical Coordinator will cont nue to provide sopoo rts/ recommendations for improvement AND initiate Action Process (5223 RCA Employee Conduiit Policy and Disciplinary Aotlc Form for guidelinesSuoemisorfCiinical Coordrnetor ill audit the some- semina?worghop within a one Week duration to monitor perfonnance Improvement .. iv: Step Mongoing {fo uriilr'I- or additleoai aodlt resulting in 855 wrsorIClimcel Coordinator will mn?nue to provide -I R35 Supervisor/Clinical Coordinator will audit the some I semirfariworlishop withir't a one week duration to monitor performance improvement Coordinator will schedule an ancillary supervision to h. Supervision to he documented via RCA individual Supervision Log 9. Areas of dis :usslon to include: i. Areas of Strength ii. Are 215 for improvement Au: it result {yes/no} . 1. if no, what is the Performance improvement Step (see above) 11.2.16 2. If no, R55 Supenrisor/Cllnical Coordinator is responsible to complete all forms and procedures outlined per the RCA Corrective Action Process 6. RSS Supe'rvisorIClinlca Coordinator will share results of RSS facilitator audits with Clinlcal Director during regal rly scheduled supervision. its in RSS Supervisor/Clinical Coordinator will immediately notify ector of audit result and Performance improvement Step a. if an audit re 7 RSS Supervisor/Clinic Coordinator is responsible to arrange For all necessary supports that may be included within Performance improvement Steps incorporatlon of RCA Clinical 'l?rainlng tea etc i . g. - 8. R55 Supervisor/clinl Coordinator is reSponsitJ?lzlefto?oom plowing-quarterly R35 facilitator. Audit Tracker-to incl do: gr . a. RSS name b. Data ofAudlls) - c. NameofSe inarorWofkshopaudited I Audit Result {yes/noi- J. . Performanc improvementStep (when necessary) 1? - 1. n. ?oord?metor is responsible to email the Quarterly R55 Facilitator Audit Directooand the Corporate Director. of Clinical Quality Assurance no later close of- the quarterQuarter 1: 'clce'r duo is}! April. 53? in Quarter 2:1; some? by Jul} 1 . Quarter 3 "clcer d'ri? 55}. October Kauarter 4: aeker due beonuary 55? 10. Based openrresults on; tire Quarterly R55 Facilitator Audit Tracker, Clinical Director a ndjor Corporate Direfqtor fClinie'ai Quality Assurance may recommend additional performance improvement Steps 3r modifi?cations . 11. R55 Facilitator Audit Tracker will be reviewed at. CIA Meetings 11.2.15 '0 11 Recovery Centers 0f America Necessegg Clinical Dacementation Assessment BraiuationD cu amentatien 1. Background Beta 3. Name Age Ethnicity Gender?i Marital Status Employme Status Living situa ion Legal iniml meat Family hist ry Relatienshi with family, friends, or others Referral 80 rue Date Enterl gTreatmenl: 2. Gather information about the presenting problem. including history of presenting problem, from the patient?s erspectiue and are,' additional sources available at the time of admissien a. Must inclu as ?why now? factors related to their current need fair- treatment i. happened prior to patient entering treatment? ii. De all patient?s reported stressors Patient?s ief complaint in their ewn words History of resehting illness Mental Sta us lore detailed use of all potential substances including but not limited to: 1. Alcohol 2. Opiates 3, Sedatives 4. Hallucinogens Cannabis 6. Stimulents 27o: Renaissance Blvd., Floor, King ef Prussia; PA 19406 Tobacco - ii. Detail the following related to each substance reportedly used: Amount 2.. FreqUency 3. Route . First use - . . Most recent use . Cur' nt withdrawal iv. Co i. Cooccurrin behavioral health and conditions j. Trauma his Medical an current physical health status Current Medication Pati ent?s ist at least two] What is patient?s ellne functioning? Potential Barriers care Patient?s initial tree ment goals in own Words an These are't JOB incorporated into treatment plan - . I 8. Substance Abuse luatlon based on ASAM I a. Include do iled information based on 6 dimensions i. Ac intoxication and/or Withdrawal Potential ii. Bio edlcal Conditions-and Complications Em tional, Behavioral, or Cognitive Conditions and Complications rinses-94 i. 1? about each dimension 15 causing problems related to patient?s' level of ii. 1: about each dimension would cause safety concern should the patient not be In an inpatient setting? 9. screenin using SAMHSA 31 approved Screening tool (CIWA 10. Use of the Clinical I stitute Narcotic Assessment for patients with narcotic withdrawal 3. Recommended by ASAM 11. Laboratory testing and Vital Signs 3. Blood or or no tested for abnormalities - la. . Screening forinfectlous disease: HIV or Hep c. Pregnancy "eating I 2701 Renaissance Blvd., 4* Floor, King of Prussia, PA 1940.6- Continuing Core Documented; 1. Documentation rr 5. Docume must refl: b. Treatmen i. ii. l? 6 c. Patientir When dc interven e. Case Ma i? I ii. LU. ust indicate "Active Treatment" . atlon from each discipline (Therapy, Nursing, Medical, Case Management] - Ict patient contact and content of contact - pian' Is formulated based on the f?why now? factors leading to admission oals are clearly established are objective measurable, and include the Itient?s baseline. "egress, or lack thereof toward reaching each goei Is documented based ASAM (see Section 2) oals related to Case Management are detailed on Treatment Plan. valvemen?t' In scheduled patient treatment activities :5 docum ented his includes engagement with medical staff' to establishing a medication Jutine, if indicated. Ail planned medication tit-rations should be ocumented. I I patient is not attending treatment activities for any reason, this is clearly commented and alternative programming is provided. The petient asponse to alternative programming is detailed in medical record fforts to engage patient to participate In treatment are documented 1. This includes engaging patient to include supports in treatment and provide consent for coordination of care with current treatment providers. contenting ongoing problems that are being addressed in treatment, an ion to address the problem needs to he documented as wail. Iagement is actively occurring and is documented. *atient?s totally and other natural supports are contacted for collateral 'nformetion and said information is documented for treatment plan. 1. Consent is provided and contact is made with supports such as, but not limited to: a. Family in. Recovery Homeric c. Outpatient Providers I d. Case Management services through the insurance company or community provider o. PCP f. Sober living houses 2. Plan for family sessions are established 3, Ongoing coordination with supports is documented Community resources to be utilized at discharge are located and secured. This can include: 1. Sober Housing 2 Vocational Counseling .WNA grams 4 Outpatient 3p pointments,? step down plan 2. ASAM Note (SuTamory for UR Review) 2701 Renaissance em, 41}! Floor, King of Prussia, PA 19405 n. nan?I. . . W. v. b. Conside I. 2702- all Documett medical necessity related to all 6 ASAM Dimensions mminent risk related to each dimension as applicable document assessment related to each dimension and include remaining safety :on terns]. . irogress made toward goals related to each dimension in speci?c measurable terms. continued plan to help patient achieve goals identi?ed on treatment plan. Document in detail If patient has not made progress toward goal related to ASAM Dimension and identi?ed new goals for patient to work toWards. Document, in detail, any new problems that have arisen during the course of treatment and identi?ed goals listed on treatment plan. rations for documentation on each dimension Dimension 1: Acute intoxicatioanithdrawai 1. Remaining signs'of withdrawal? Are there post-acute withdrawal still evident and needing treatment? (Fatigue dizziness nausea, etc 2. Vital signs . 3. Plan for intervention related to continued withdrawal 4. What is the risk related to early discharge with these present":l 5. ?Continued monitoring needed due Dimension 2: Biomedical Conditions and complications 1. Have patient?s physical illness issues been addressed in treatment? What medical illnesses are being actively treated based on the . treatment plan and medication orders? 2. What treatment complications are present due to medicai issues? leg, physical pain causing patient to he Unable to attend all groups and is being actively treated. Expectation that pain - will resolve within a few days and patient will be encoweged to attend full schedule at that . 3. What is the continued, multidisciplinary plan to resolve the present complications? (eg, ongoing evaluation by medical staff andlor continued needed In order to help patient obtain insight into managing diabetes as resoiting trigger. patient to crave use 4. Has Case Manager coordinated with current outpatient treatment . providers? 5. Has Case Manager obtained records from recent previous providers? How has this been incorporated into the treatment plan? 6. Does Care Manager need to schedule discharge appointments and transportation plan for patient?s medical condition to be addressed post discharge? Renaissance Blvd, 4? Floor. King of Prussia, PA 19406 2703 )imansion 3: Emotional, Behavioral or Cognitive Conditions and Complications 1. What chronic or acute conditions are being treated In accordance with the treatment pian? 2. What progress has been made towards treatment goals? H1 measurable speci?c terms? 3. Risk related to premature discharge? what continued treatment needs to occur-in order to ensure sustesst?ui tra nsitionto next level of care (how is patient going to manage col?occurring 4. is patient currently able to manage activities of daily living? What Is the plan to. improve patient?s level of functioning? 5. Has the Case Manager coordinated with current outside providers? Is this information incorporated into the current treatrnent plan, if indicated? . . 6. Does the Case Manager need to coordinate a safe discharge plan . that includes follow up for condition? DimenSicm 4: Readiness to Change Goals 1.. How has patient progressed? In their readiness to change since admission? 2? What is the risk associated with discharging patient prematurely due to their current status? a Does patient lack with continued resistance which would no use risk to themselves or others if . discharged? I 3. What speci?c goalsare being worked on to facilitate improved readiness to change? a. What intervention; are being utilized? What has worked in the atment thus far? . 4 Has Case Manager/Therapist scheduied a family session forthe family therapist and patient/family? Dimension 5: Relapse; Continuad Use, or Continued Problem Potential Goals 1. What ?here and now? concerns does the treatment team and patient have related to potential for relapse? a. What specific goals are detailed on the treatment plan to help increase relapse prevention skills? 2. What programmatic components are being implemented that will best assist patient in the moment? a. Speci?c types of groups coming up in the next few days, upcoming family meetings, additional support meetings 3 Has the Case Manager coordinated a safe discharge plan with the patient In order to assist with relapse preventloIi? a. Schedule appropriate step down appointments b. Scheduied transportation Renaissance Blvd, Floor, King of Prussia, PA 19406 vi. 3. Progress towers a. Adatab i. iv. a. bi c. Coordinated with ali supports about continued care plan post discharge 4. What risk is Indicated should high potentialfor relapse continue to exist? Dimension 5: Recovery/Living Environment Goals 1 What supports have been established over the course of treatment? a. Case Manager has coordinated with supports and has opda ted them on treatment progress b. if this has not been established, continued plan is to work on further enhancing natural and community supports c. Case Manager has completed referrals for patient needing support in their communityI early in treatment shouidthe patient report a lack of natural sopport. Can the Community Supports identi?ed come in for a meeting prior to patient discharge to establish rapport? . 2. What resources have been put on place for aftercare? What needs continue to require attention following discharge to ensure safe living situation. a. Aftercare appointments . - b. intensive Case Management {either community based or throngh the Insurance company) - - c. Sober living house d. Vocational planning a. Financial resources . f. Transportation g. Childcare h. meetings 1. Anvapiritual support needs 3 What risks are present should any of these steps not occur? a. How would a lack of planning on Dimension 5 impact successful treatment completion? Case Management goals related to Discharge Planning tee of supports is obtained and includes: Consent for coordination of. care Phone number Email addressm?. Relationship to patient includes list of individuals that patient has used with in the past and friends, that can identify patient?s whereabouts In case ofan emergency etion with each support identi?ed is completed and all collateral information related to patients ailments and history is documented. a. Medical (1. Familys _2701 records from prepious treating facilities are obtained ession is scheduled Renaissance Blvd, 4th Floor, King of Prussia, PA 19406 9. initial discharge plan IS develaped i. Referrals made to aftercare resources {see 2 13 vi. 2) fl S'ummam of Case Management Plan is in chart 2m: Renaissance Blvd, Flam, Ring of Prussia, PA 19406 Agenda: Chart Audits Real Time vs. retroaitive than: auditing Role of chart auditing' an 1.05 and sowey/audit prep Quantitative, Qualiti tlve, Continuity of Documentation Service Delivery 0 Role of CIA . 0 Role of clinilal supervisory 0 Role of U8 - RCA expectations fo? chart audit 0 RCA CM Ad in Supervision CM. Therai?l Basic Requirements Treatment am - Supervision Protocoi Case Management Protocol 0 Documentir for insurance Staff responsibility - Auditing of me's chazts (awareness of what is complete/what is missing) 0 Collaboratic to ensure comprehensive documentation in chart across multiple practices (b compietion, treatment plan deVelopment, continuing care plan developmel t, case management protocol, treatment team] a Responsive-mess to group'and individual feedback (supervision, treatment team) 0 Preparednessforsupewision )9 Supervisor responsisility Auditing of shorts within department 0 Awareness 31" patient disposition vs. chart disposition I Uni oing (day4, 8 11,18), prior to UR review, 24 hours prior to discharge 0 Communication with other departments to ensure oomprehensive chart auditing (QM, UR, Case anagement) - . Creation of auditing as necessary Maintainintsupervision protocol and schedule 0 Ensoring adherence to RCA guidelines 0 Treatment team agenda Cm Therapist Basic Requirements Treatment Team Sui ewision Protocol Case Management Protocol Dolmmenting for insurance Gil icai Trainings 0 Real time and structured [supervision] feedback 0 Staff accou nobility and growth to include preparation and delivery of supports for staff progress (it increased supervision, additional training, etc]. Avatar functionoii?or - 0000 00000 Chart View Quantltativ? management reports -. .?ocumenm'tloh 3} 1-1' Qai?z- - Therapist: Compiate Thampisix Finallze - Biupsymoaoclalforpatox Therapist and Case Manager . . . begin gathering data for Admisstons to Treatment Planning within 24 Treatment Pian Update or semen and . Treatment Plan for 9ng collect llama after Finalizad. - Dem Due Trealmant Plan ?nalized for . . MD facilities. .5 lb: Obtains consentrf Therapis?Family . Admissions unable. Inmate . - . . 3r:- Admissions to contact with Famify within 24 a ?3??ch v1. .51? g, obtain consent. hours. Obtains collaharal I - information. Schedule Family med?? ?rat'm?somare' . . ay?r. E3 . gang; . Session game?s 13.1?giqi??'2353? $333ng! I Therapist . 'fo tie at GROUPSESSIONS Complaiad 1st Ramsay: 95: kg? ya i? Sesslanonurprior Tn DAPFORMAT 1 May? nu. . THERAPY ngqummeujs sonwarmi?s. sax?if? ?1 The?piskUpdated .. - . maramstmust . ASAM note - 111-3135 update note completed or! day v.5: by 5th day for 7(sarne forPC) and it Baron: and attima before every g; . '?ftigg?" Ki: was? -- Distepdm schedutedUR JG. - ?3 JawLiaCase Manager (CM):nbtain 8M:Gontinua Therapist: Prov-Ede oulstanding consents - ?rm. 5:31; Admissions to . attempmto contact Update on -. obtain consent furooilat?ml treatment programs . "We? 'nl'o ti 09111 ra 't 51:1 records tuinfonq'rxf'lan mm on a p13 .. ?3739532135? ?43CM'DIscuasien CM?fdfcoccuring 3 Manageucwndam w??patlanfof 3% possibie patientdismarge Con?nuingcare Ia ?u pt . needs . Fiat} ~Purpoae. nan :3 use . . ?pa 'i'rcare . r. - meetings. unmni'ate preiimtnary diagnosis Medlcal: con?rm: an [Her modi?as mammals at?ma of medical mmem. Therapist: mm and confirm diagnosis as part of?nallzaitnn of When! plan facilities) I . . a Therapist reviews a widenn?mm jig-2' . diagnusls as part .2 . - of?natlza?onof - {reshnenlplan -. 3 a . I . Z.- 5-4: - . - . . (It - - . :ripyisq 5 prior In day 1 {Indicated ,Tmemptan . . . . Updataa "due-every in - - 15 days. 9 "1 Treatment!? nUpdate .due. ?Updat rasneeded ThempfsUFamiiy memt I #afntafn Ensure weekly documenla?qn of . I gg??a?he?? mnfaof ME: I Fam?y Updates from 1' j. (ongoing!) a rate ev famil tm - - basiatad.achadu?e?lc pt - 6 _en .55: - Fan?fy Session 90 dais ?mms' f: ?5 concerns - . . ?Completed 1 q. IndividUaISassion . . 1 ., . awaly?rdagya. .1- . :3 g: TherapistCompfeted 2nd Therapist ?ti 2' a Session on ori?rinrtu Day formulates plan - 14 that anahlas c?ent 3 '3 . -, 23 ..: transislion daynf 5,3353 I .h . 1: . Therapist: '31 g. 1; ,Tharapist UpdrtedASAM completing awry? we": . ?1 note complete: on day 14 days ongoing and and hem: every before every I. .31: 1' -. . achadulad uLxmuraw s?heduied UR I 2'1? f' Review . 3' CWTherap'r :Provlde .. . . Weekly upda to GP 0:133an 38?? Providars pda cm- Establish J?earda?o pian.MeetwithP124 - hours priurtudachargeto CM:Gon?nueschaduling r??e??phn. plate aftercara,set up phone: Continuing Ga calisw?h F?a?enland e. - aftercare providers to Papemark. will foisow establish rapport. Up with a?erca provider ,3 - Holmerlhani? 85's from :1 .2 7. date of schedu c1: appointment. 1? . TCU Getting Motivated to Change Supervision Checklist Supervisor Name: I Sta?? N31116: Date: Criteria Met Not Met sassion start Facilitator was scalp and prepared 10 minutss prior to n. group?parhmpants Eamlitatehhad sum?ci'?t hand +ts $1121 Worksheets forzall inf?" .. Facilitator welcomed each me? 1b er to the group individually .. 3. P3136111 519113 0 ?5 Facilitator actively moderated group discussions ensuring no one participaut dominatcd the 4ponversa?on I . Facilitator kept t?e ?lm strengihs?basa ..-- .35? . maps and worksheets indEpeanc Fao?itaior provided time for gqoup pai?tiuipants to complete anti}! . Fac?ltatnr providb? 1.. content Facilitator used Target Log tilting the group checknin Facalrtatnr 2:3de '21] group part you do tower}: 0'1} year?ta: 'a the ?rs?hmg Medication-Assisted Treatment in Opioid Addiction? 4.6 (7) .Con?nnatlon 335332046 militant Expiration 313112017 Type "5 5m: Compliant . Desalpaon (ObjecuveiPurpate) - public health madam. Its effects or} individuals, as well as populalims, is course is largetiad in a bread heal?icare mm, iridudmg . more advanwd lavels of madicatinmassism deal-men?s experience. By problem and giving the de?nitions of opiates and the pmaesses is mining dismisses the principles pf effedive medim?onassistied . addiction tteatmt, midi al emphasis on assessing the opioid-addicted individual who seeks care. Using Vitriws teaching tools, lthduding insmx?ve infomatim and inheradive exau'sec, this advise will haip van to formulate a plan care, 90315 for mm, and mn?dmtiality gt?dalines for Individuals seeking treatment in your setiing Stap?by-step guidelines derived from the Substance Abuse and Mental Health 53311in Admit (SAMHSA) Wiedkra?nnwassisbed mm: for opioid addidion: Fads for families and mantis will further twist your learning and applica?on of these mums: This murae is appropriate for anytime who may be lnvoiveci with the We?: of opioid addlcilm. Toma addiction is a signi? are {may and burdenmne. individuals either basic dearly de?ning the scope of involved in opiate adc?ction, (puma Outline i- .. i Section 1: Inhaduction A. AhoutThis Comma I B. Learning ijaotlveq Section 2: Opioid Addict! - A. manafaei . B, smegma 4? (I. More Abcmt Opioid D. What Are 011mm? - E. Opialm and the i- F. P1399115 - Add: - l1 Opioid Addiction lction ?3 - H. Charada?is?mbf - LcanmnTaI?sln oldeiGn 3.Test Your K110 - Section Summaw F. What (5 Medication G. Madka?onsum H.1?laan111esa- I: Dwig?sand . . - D. Mare for Ens . P. Eda Effeds of Med! . Q. Comm Ede Effec R. Adjua?ng Medlcatia - 5. Come of Treatmen . T. MAT Programs Are 15 - V. Wchad's Medica? - W..Sectiori Summ- 1* 9.111e1ndividuaiizedl care?nly Problems? In Persons Who Are Opiqid Addicmd ?Ian of Care a E. Counseling . F. Family and Friends doe Important Too! I Groups . H. Goals for Recovery m? Uplold meme . Let?s Pradioa?evei log a Plan oil-Cane . Con?den?allty Gui mes . i - - K. Con?dentiality and vacy Speci?c to Opioid ?lieatment - . L. Than'Sto Pamembe . M. Rafael Continued . o. Section Sur?hmary Semen 5: Conclusion A. Summary 0 B. Resoumea . C. Rom About Opioid Addiction and Treatment - Looming Objecthos_ 1 Discwsothe you can emoloy to eatery administer molootlons for opioid addiction. Describo'dre four clone elomento of addlc?onrfonnulate goals with the mammal who waits . ho withde from the problem Additional Infometiee opioid; . Expert Wilmer Luc Pelletler MSN, open, so, Fem Mr. Pelletler, Emonlzlal Loamizg's Senior Hoaiihcare Quallty Consultant, has 27 years of expe?ence in the behavioral healthcaro and is a licensed nurse. His amortiso is in the areas of managed behavioral Melba-lemma health and addictions nursing, clinical lnfomieocs, quality and perfonnonoe to qual?y, policy developmwt, afld amedltatlm and ragulamfy complianm. Mr. Pelietlor has impressive edlho?al resume as editor, oonh'ibulm or reviewer for {Hauler nursing journalo. Ho peerarovleloed journal of the I currently the Editordn-Chief of the Joumal for Heal?lcam Quality, :1 Equal associa?on for Quality a?d the redolent: of the APEX Award of omlimce in many :atego?os since 2002. Me Pella?or is Fellow with the Ameieen Amdemy of Nursing, the National Association forHealthcaro Quality and the American College of Mental Realm Administra?on. Diodosoro: Luc Pelletler were at, FAAN has declared that?ne mn?lcl: of interest, Releval?ft .?nariolal Rela?onohlp or Relevant Non??ne nclal Relationship allots. up Staff Writer SteVeJenldne, PM): Dr. Steve Jenidns, is a counseling and a professor at Wagner Coilege in New York who has extensive clinical erdper?se working in a variety of behavioral heel Were settings, indecrmg oollege counseling centers qumatlent clinics, hospitals, and oorrectlons facilities. He has developed workshops and trfainings on oeducatlon 'and best practices in eVidenm-liaeed Individual and group peydrothe'repy, Dr. kins is an assotlete fellow and oompleted his post-doctoral training attire Albert Ellis for Rational Emotive Behavioral Therapy His primary research interests are sleep, healer oognilivee behavioral therapy, and positive He has been published lri ten journals and boolre inclurrmg the Journal of College Counseling, The Counseling iogiet, Contemporary Family Therapy and Counseling Quarterly. Dr. Jenldne also uiarly presenters his research at national conferences Disclosure: SBEVB Jenkins, has dedared that no conflict of interest, Relevant Financial Relationship or Relevant Inencial Relationship exists. Target Minnelli The lergel: audience fertile rse is: entry and inbormediete level Alcohol and Drug Counselors: entry . and intermediate level Nu entry and lntemediete level Professional Counselors; entry and intennediate level Social :enhy level II: the following settings: Health and Human Services, Hoopitel, entlAmbulatow; and lire following prediee wtego?ee: Addictions General Home Health, Mental Healer, Pain Management. Relies learning has a grieve oe polio,I in place to facilitate reports of dissatisfaction. Relies Learning will make artery effort to?reerrlve eadr grievance in a mutually satis?erzlory manner. In order? to report a complaint or grievanoe please oonieot Relies Learning at If you require ajdations to module, please contact Relies imming meterner? Supp?l't by calling 806) 331-2321 or emailing sepport?lrellesleamingmm. To earn continuing edu credit for this oouree you most adileve a passing score of 83% on the poet-test and mpiete the oouree evaluation. Reviews - a a ?We; Reviews Module: Triggers and Cravings Ctirniio'nents icebreaicer - Activities Sticky moments . Videos Materiais Needed I. Dry Erase White Board Do,f Erase Markers 1. Triggers and Cravings 1 6 Introduce seminar - minute . . 2- Recovery Cycle . 3 Ir - What is the differente between a trigger and a craving? . minutes - Triggerieads to a craving. in Use coping skills to heir; ease the craving from turning into - relapse 3. - Objectives 2 Defi ne what-e trigger is and types of triggers. minutes 0 Learn where a traving comes from and what it does to your brain. I a Recognize how triggers ieati to cravings. a identifyways to cope with ttiggers and cravings. 4. Classical Conditioning 3 introduce concept of ciassical conditioning 1 minutes it Reference Paviov?s experiment I Video . Human brains are wired to help us remember pleasurable experiences. Pairings of pleasurable experiences become automatic responses with repeated conditioning over time. The same process applies to addiction and when we use - substances. 5. Training the Brain 2 - The intensity ofthe ?Zing? batman the thought of the minutes activity and the pleasure receptor creams a deep connection (superhighway). I Thinking-about using the substance can highlight the . receptor, giving Us a taste of the high without even using. 6. what is a Trigger? 3 4- Define a trigger. - minutes - Triggers can be anything that the addicted brain associates with the reward of getting high. a Triggers may cause a person to relapSe or engage in a behavior they are trying to axioid. . 7. Triggers Are Based 2 - Triggers can be created from anything dates, minutes demographics, personai preferenoes, behaviors, and internai and external factoris) 8. Types of Triggers 2 . internai triggers: inside of us (thoughts, erections, or minutes physical sensations) External triggers: outside of us (people, piaces, things, and_ situations. Narcanf" [nabs-{one} gives can named heip ers a window (If apportunity to save a life by pmviding extra time to call 911 and Carry out iescue breathing and ?rst aid until emergency. medical help arrives. Triggers and Cravings! Rescuer? . 1 minutes Lea rning the processes of triggers and cravings pan help you identify ways to Cope with them By learning how to Identify your personal tri?gers, Implementing an action plan to stop the trigger, and learning how to stop the craving turning into relapse minimizes risk and promotes healthy living. hwnagsazaanaSauna} nv?nUEukn?m Ea HE . ?annuaI1. WESTMINSTER A RECOVERY OF AMERICA COMPANY 9 Village Inn Road W?stminster, MA 01473 (978) 571-6050 Hello, Welcome to Recovery Cea tors of America (RCA) at Westmins?m ?we?re glad you have trusted us With your care. We ter is a campus specializing in treating heroin, alcohol, opiates and other Substances, and anus warring disorders. An expert team and other professionals will provide compassionate, scienti?cally proven effective treatment amid top notch, five?star a?ons, chef prepared farm to table fopd,tl__1e most comfortable mattresses and bedding, in the beautiful heart ofNew England. -- Substance Use DiSorders are a chronic, life?threatez?ng disease that diminishes the quality of life We applaud your decision to enter- treatmeat and understand it may not for you and your family. have been an easy one. This handbook is dGSigm?f to familiarize your-With all of the services and resources available to you; We Want you. to feel to treat you with a 5-star at?home and comfortable daring your stay and know that it is our goal patience. Please let any Westminster sta? member know if you have any questions. A new pa nt orientation occurs within 2.4 hours of admission. Our program combines primary counselor, you needs, abilities and prefe integrated approach to Substance Use Disorder ire-anneal. With your tailor an individualized some of treatment based on your cos. Together we will create a personalized plan for your recovery . that Will include individ and group counseling, medical and serviced life skills development, workshops leisure aotivities,physioa1 education, relmration techniqms, yoga, massage, reilci, acupnnc 'The Treatment Team eonsi Disorder treatment, Nurse Level Clinical Leadership, and certi?ed holistic pract Family recovery is an inn: - have regular phone center: and visits according to yo family educations sessions group open to all W?dnes: Westniinster employees at and family counseling. sis of Board Certi?ed Physieians skilled at Substance Use Practitioners, Registered Nurses, Licensed Practical Nurses, Doctoral Masters Level Licensed Clinicians, and Recovery Support Specialists, tioners ortant part of the recovely process. You and your family therapist will or individualized plan. Our family program alto includes 12 hours of available tn the evenings or weekends, and a family community support lay evenings from 6:30pm?8130pm. 'e a dedicated, knowledgeable and professional team. We are here for you, your health and the health of those you love. We wish you success with your treatment, recovery and health. with your chosen family members and will schedule family counseling um -I um -. Ino- swim mime: 1.151131, suns Westminster is accredited by The Joint Commission. Westminster is also licensed by the Massachusetts Departtneut of Public Health, the Commonwealth of Masseehusetts Bureau of Substance-Abuse Service ., the Drug Enforcement Agency, and the Substance Abuse and Mental Health Sendees Administration We believe that people suEfering ?om the disease of addiction can recedes Our mission is to . save lives?by treating add' tion with evidence based treatment. services and ongoing recovery support. Through om.~ adv easy work, we will become a disruptive force fer change, reversing the stigma of addiction and those who suffer from it.- . We will develop an innov: dive clinical treatment program which integrates the leading res earoh and technology 111 the ?elc - We will shift the focus remote treatment seniors to localized treatment where the entire community is engaged covery. This neighborhood model will encourage education and create opportunity for change - We will he a disruptive to so for change. As champions forour patients and their families we will use the legal system i ?ght inadequate care whereby insurance companies dictate poor 1 treatment. I . We provide you with a copy of your individual schedule each day. It is also posted on each unit and in common spaces, you have questions about your schedule, please ask your p?mary therapist for assistance. - Ali . .F - Westminster has an noises-sling commitment to our patient?s health, safety, and well-being; We believe you have the right to a safe and secure environment, ?ee from alcohol and other mood altezing substances. Our mission to provide the absolute best treatment, with the highest level hf Safety andseoority, begins with a drug-free campus. For. the safety and security of all Westminster patients, we expect you to ?respeot this commitment and help keep Weshninster 'a drug ?ee environment. To ensure that Westrnins sta?" and all visitors; upo will conduot the ?011on An inventory of in a treatment feel events. A medical safety An unannounced suspicion exists. Lineman: so campus events; and-n where substance use 1 ter provides a druglalcohol free and safe environment for 0111 patients :1 admission and entering the facility from any outside appointment, we )0 ji- 1- belongings brought into the facility Any items that are not appropriate lity will he whome stored or discarded. A search of bags end belongings hrought' mto the facility upon your return from any outside search upon admission. room Search of patient?s rooms or other possessions if reasonable rooms are conducted at the tiree of admission, upon return ?om any off mdomly during the course of treatment to verify abstinence orin cases 3 suspected. - Recovery Centers of America accepts most meior commercial insurance plans.- Reccivery Centers of Am outpatient sendees. Thee fee scale policy Reducec Customary charges. Acute Servin ATS programs are medic - nursing care, under the from alcohol and other d1. Human Services, zois). medically cleared and he Clinical Stabilization 038 offers 24-hour no abuse. Typie?ly, clients arica may in certain instances, provide reduced fees for inpatient and i are determined on a case?hy?oose and subject to the company? sliding fees are calculated based on a discount of the Facility? 3 Usual and LEVELS or CARE .es- (ATS) (Beto??cation) ally monitored detoxi?cation services. Programs provide 24-hour pnsr?ta?on of a medical director, to monitor an individual's and alleviate (Massachusetts Department of Health and When patients have completed the detoxi?cation process they are nsitioned to a lower level of care. . rvices (085} out usually following Acute Treetrnent Services (ATS) for substance stay in the program for 10 14 days, during which they receive a range of services ineiuding nursng, intensive education, and counseling regarding the nature of the addiction and its oonseqr beginning to engage in It enees, relapse prevention and aftercare planning for individuals oovery from addiction. These programs provide mt??disciplinary treatment interventions and emphasize individual group and family Linkage to aftereere, relapse prevention services, and discharge plowing (Mess It is your responsibility to Please avoid the use of pa Staff membets are always sessions and aiming your 1 has a zero tolerance polio: You are responsible to ate, remain until the end oftht Please bring your pen ax?td elf help groups, such as AA and NA, are integrated into treatment and achusette Department of Health and Human Services, 2016)- treat other residents" and staff with respect sad dignitj,r at all times. Jfanity. available to discuss feelings of anger o: ?ustratioo is individual group meetings In order to ensure a safe environment, Westminster for any type of assaultlve or threatening behavior. 1nd all activities, groups, and 12~Step meetings, arrive on time and session unless medical or clinical stat?t'have approved your absence. notebook with you to each group, meeting, and counseling session! Gambling in or on Weatofnster property is not permitted. Shoes must be worn at all Patients are only allowed For your safety, ?sta?' routl For your convenience, we times. :0 enter their assigoed bedroom. nely check bedrooms at vatious times. . have provided designated smoking areas at the ?re pit and the healing garden. Please somke' in these areas onlyr It is prohibited to hoztow 1 :lothes or any other possessions ?ora other patients Sexual/romahtic relation Televisioii and cell phone withdrawal management residential unit allows for o?ce. Residents are not Westminster reserves the violence, substance use 0 or other patients at risk. 1 appeal. The process is ps ale not pensitted during your stay at Westminster is only allowed duriog time. While in the cell phone use and telephone cells must be approved by staff. The ditional supervised phone use scheduled each evening in the RSS owed to carry their cellphones - 'ght to adtt?nish?aiively discharge any patient due to physical er sexual campus, and/or other similar behavior that puts them, our employees a patient is administratively discharged, they have the right to an ed in the Patient Grievance procedures in this handbook. VIIT I We recognize and appreciate the value of your loved ones being involved in your and their own recovery. Therefore, we encourage you to spend time to gather.- "Yisiting hours are: . a Tuesday 6:30pm-a8 00pm 6 Saturday 1:00pm-3 :OOpm 0 - Sunday l:009m~3:00pn1 I Visiting locations include the fainily and admission lounges, as well as the Great Room, if necessary. In addition, we have a family therapist and individual therapists available throughout the weekendsand evening, as well as other support stall; to assist your family to theiraeeds Please discuss with your Psimary Therapist any visitation questions or concerns. To ensure patient safety, all visitors need to be on your Approved VisitorsList, which can he initiated and updated - ?dill your Primary Iherapi a. PleaSe note that visitatior. is determined on a case by case basis while in the withdrawal management program Please let Your visitors know that there are certain prooedhres we follow for their oomfmt and safely including: - 0 Ask visitors for id nti?cation; leap eel: all ineo packages; :1 Allow visitation o1 ?y in approved areas; . in Ask that handbags electronic devices, mobile phones and food and d?nk romain in cars EAMILY PRO GRAM- Sobstanee Use Disorder is so powerful that it novel affectsjust one person; the entire family system is hurt. In addition, the fem?y system can either serve as a trigger for substance use, or as a support for success rate intreating Substance Use Disorders goes up dramatically 1f the most signi?cant people in your ll] are involved with you in treatinent. Westminster acknowledges this . and gives . high importaooe to providing a comprehensive and quality family program. W?shninster?s Family Frog-211i makes it possible for family members to gain perspective on this disorder, get support for the nselves, and learn new ways of supporting their loved one?s recovery. Westminster? Family Pro g1 am: Provides up to 20 have been-Witness Is open to family It . place in the Greatl' Our family come ours of education, therapy and support to those family members who 0 their loved one 5 Substance Use Disorder. . embers, spouses and signi?cant others ages 15 and older, and takes room or a smaller group room, if available oity support group is open to all, including family members of past arid current Westrragwter patients as well as the local community It runs on Wednesday evenings from 6:3 ill-8:00pm. This group is professionally. facilitated but member rim. - Participating family members share concerns, questions, support, wisdom, strength, and hope. - Educational sessioa's are open to all family members of past and current Westminster patients. These grr. p.111. and from 1:00 7:00 to 10:00 ups are provided on Saturdays and Stmdays from to. They are also provided evenings mi. The sessions are cycled so that participants cart complete all 4 .- modules within a reekend, across 4 weekrrights, or a period of 1, 2, 3, or 4 weeks. I In addition to these family and support group o?'erings, your Primary Therapist aadlor Family Therapist will encourage lad arrange personal family and couples-merapy sessions throughout your treatment as needed. . PleaSe discuss'this aspect of the program with staff and encourage your foamy/support grbup to participate. It will ease you transition home and enhance your recoVery. The Health smartp one platform is a great tool for you to utilize in your recovery It combines one ouragemeot, pport and ac and provides an amazirlg opportunity for you to track and manage or own sobriety TriggR will help you to: - Traok your daily gross and celebrate your aeooroplishmeats 9: Better assess three to your recovery and track triggers a Frovide 24 hour/'3 ya a week roa1~time therapeutic support 3 Locate aearby mes gs aodfor treahnent Supports I: Stay in contact wi others irt recovery Inorease yourvaWanmess of mood changes, stressors, and . Case Management staff will be meeting with you during your stay to talk more about this opportunity and assist you with the Sign up process ?m . MW free times. The Patient Portal smartpl a?er your treatment stay. sense of community, colla details. Communicate View your echec I VieW your treatn .3000 Access and com] Track your daily I Access the patio] All patients may send and PATIENT PORTAL 10116 platfonn' 13 an interactive program for you to utilize during and It allows You to actively engage in your recovery Wl?le maintaining 3. hereto with peers and treatment team staff and review treahnent This initiative is process The Patient Portal will help you to: th your health care professionals ule? rent plan goals, objectives and interventions View past and current medications Jlete educational worksheets mood and days sober 1t handbook SP receive personal correspondences. Outgoing mail can be dropped off to the receptionist. Westminster W111 provide postage and atrange for pick up. All incoming mail shall bi does not contain hazardou member, Wes??i?sf?r. Will cost to you. We will also program. House phones are available Phone. calls are limited to NOTE: The ?rst 5 daycy during free time. Cell phones will be secure room so they are safe until your personal phones, this made. op erred by the patient with an authorized staff member to ensure it a materials. If you choose not: to have your mail opened with a staff send the correspondence or package back to the original sender at no return mail to the sender if it is receiVed after you have left the ICD at designated areas on the unit and will be armed on during speci?ed .??n'dnates and may be monitored by Recovery Support Specialists ouw?l need approval ?ora your Prinzary Therapist to Use the phones 1. Ifyou bring them to treatment, we will secure them in clocked the time of discharge. Ifthere are instances where. you need access to will be approved by your clinical team and accommodations will be E?Readera withoitt access: For everyone 5 safety 0 the internet are permitted during free time. UABL comfort valuables, money, jewelry, etc. should be sent home Westminster cannot be ponai?ole for any articles left on site a?er discharge Clothing and/01' valuables not claimed wi .SMS . For safety pulposes, West designated m?old'ng areas to smoke. Patients are pennitted to 1+ maat?bring in new, unopel accesso?es. The charging: order to ensure it meets ear same guidelines as eigalel scheduled breaksi 30 days of discharge will be de?ated. iT KS AND master is a smoke??ee building. For your convenience; there are outside Please check with a staff member if you are unsure of where 5e enoigarette/vaporizers, however, for the safety of all patients they led and labeled e?eigarettestvaporizers, bottles of eqliqttids and devices mast heassessed and approved by sta'? upon admission in fety measures, Patients are permitted to utilize vape?zets under the te smoking, outside with staff in designated-smoking area during Staff Will secure emigrate es and vaporizers when hot being ttliliZed. Patients are not permitted to build their own soils 0 bring matetials with them to build coils duriag their stay Wax vapes, oil vapes, e?hoolc In order to ensure a seem: ,and herb vapea are not allowed 0 CO r' environment video monito?ng will be used at all times in common areas to ensure the S?f?tj?l security and maintenance of a therapeutic environment. At no time will there he video monit Your room will he servit Please do not tape anythix. )ring in the bathrooms, shovtiers, or bedrooms armaments; ed daily by housekeeping staff. We ask that you keep your room neat. gyto the Walls, [maps and furniture. Eleaae do notfearrange the ?trnituie. Westminster offers ?ee facilities. All patients are responsible for their personal laundry . Laundry facility is located on the ?rst ?oor, near the group r0 ems. - Please speak to Your Iirimarjr Therapist if you need to make mangements for professional salon services. Patients are not permitted to perfonn these services. Razors ?6111136 stored by S1a?and available daily by request to RSS during free time. Monday it I I A. 12?Step or Alternative Meeting '7'20613111 8:00pm Tuesday 12?Step Meeting- or Group Spirituality I 7':00pm' 8 :00pm ?Individuel Spiritu?lity I . . 3i00pm~9?0pm Wednesday 12?Step Meeting or-Gmup Spirituality 7:009:31 8:00pm I Individuzil Spirituaiity - 8:00pm 9:00pm Thursday 12~Step Meeting or Group Spirituelity .: 7:00pm? 8:00pm . Individual?pixitua?ty I 8 :00pm 9:00pm - F?daf or Altmnative MeetiIIg ?:00p111 3:00pm Saturday 12?Step or Altema?ire Meeting I 7:00pm43:00pm Sunday 12?Stcp orAltema?ec Meeting I 7:06pm~8:00pni 10 In the Rooms Meeting Guide Steps Away 4W Each?pa?ent receivingiserviees at WestminsteI shall have the following rights: .1. To be noti?ed of 3* rules and regl?ations the facility has adopted governing patient conduct 1n the fac' - 2. To be infanned of emces available 111 the facility, ofthe names and professional status of the personnel pro ding andfor responsible for the patients care, and of fees and related charges, mcIuMg the payment, fee deposit, and re?md policy of the faoility and any charges for servio not covered by sources of third?party payment or not covered by the facility?s basic rate 3. To be informed if facility has audmonzed other health care and educational instimtions to participate in patients treatment, to knew the identity and function of these institutions, and to lime to allow their participation in the patient?s treatmth 4. To receive from th patients physicians or clinical prao?tioneds), 121 terms that the patient understands, an ex lenation of his or her complete medical/health condition or diagnosis, - reeommended troa eat, treatment options, including the option of no neaonont risk(s) of neatment, and exp eted result(s) 5. To pm?cipate in plma?og of the patients care and treatment and to re?lse medication and treatment. . xperimeatel research only when the patient gives infonned, written oipation, or when a guardian or legally authorized representative giVes incompetellt patient in accordance Wi?a law rule and regulation. 6. To participate in consent to. such such consent for 11 Wan?? . 7. To voice grievance . or recommended changes' to policies and services to facility personnel, the goVerning au?lorlty, outside representaiives of the patient's choice, either individually or as 1 group, free from restraint, ?tterference, coercion, discrimination, or reprlsal. - 8.- be free from nitntal, sexual and physical abuse, exploitation, coercive acts by staff and other patients {1 free from use of restraints unless restraints are authorized. 9. To right to con?de ctial treatment of information about the patient 10. To be treated with courtesy, consideration, respect, and with recognition of the patients dignity, individual ty, and right to privacy, including, bot: not: limited to ,auditory and vices] privacy . 11. To not be required to perform work for the facility unless the work ispart of the patients treatment and is :erformed voluntarily, the ?ierapeutic bene?t is documented in the treatment plan and is otherwise in accordance with local, State, and Federal laWs and mics. 12. Toexercise civil and religious liberties, including the right to independent personal decisionsdiscrin looted against because of age, race, religion, sex, nationality, sexual orientation, disabi ity (including but not limited to, blind, deaf hard 'of heating) or ability . to pay, or deprived of any constitutional, civil, andfor legal rights - 14. To be transferred or discharged only forlmedical reasons, for his or her welfare or that of other patients, or ita??upon written order of a physician, cor-other licensed clinician or for faiiure to pay req ed fees as agreed by the client at time ofadniission (except as prohibited by sources of thin party payment.) . 15. To be noti?ed in writing and to have the opportunity to appeal an involuntary discharge. 16. To have access to and obtain a ecpy of his or her clinical record, in accordance with the. facility's policies proceduresancl applicable Federal and State laws-and rules. 17. To be assured sec 'ty in retaining approved personal items as space permittennless to do so would be or would infringe upon the rights of other patients. 13. To be allowed vi iting time at reasonable hours in accordance with the patient tenement plan and, if criti ly ill, to be allOWed visits ?rom his or her family or legally authorized rep; es emotive of time, unless medically contraindicated as documented by a physician in the patient?s of bed record 19. To receive prom medical attention. 12 - POLICY: 20. To have access to a; prop?ate education. 21. To litre in a safe, clean and healthy eoviroonient. 22. To be informed rights, as evidenced by the patients Written acknowledgement or by documentationb of these rights and could understand. 9' staff in the clinical record, that thepatient was offered a mitten copy Even a written or verbal explanation of these rights, in- tetms the patient 23. Your rights are protected under Massachusetts and federal law. A copy. of the law is available to you up: 1964 (42 U.S.C. 82 of 1973, as amende 1975,asamended,+ race, religion, sex, admission or access medical rceoxd info PURPOSE: ,f . Westminster pro?cient: co possible, prompt resolutior received All grievances In their designee. All patients Any oatient who has a g?ti Committee, through the fa the grievance process and at request. In accordance with Title VI of the Civil Rights Act of 300d et.seg.): '45 C.F.R. port 80, Section 504 of the Rehabilitation Act 1, (23 S794): 45 0.1121. Part 84, Age Discrimination Act of 5 C. ER. Part 91, Westminster does not discriminate on the basis of xual mienta?on, color, national origin, handicap, or age in to treatment or emplomeot in its programs or activities. Your relation is protected under 42C.F.R. part 2. . GEIEVAHCE Pagans a a?denti a1, non-threatening mechanism for ioitiatiomieview and, when tofpatient complaints concerning the quality of care or service oat be submitted in writing to be reviewed hy the facility?s CEO or are able to voice g?et'raoces Without fear ofreoriaal venoe of any kind may request a review by the facility. The Gtievance :ility CEO or their designee, is icopoosible for e?ec?ve operation of for. the review and resolution of grievances. lfthe patient served has a surrogate decision?makeol or she will be informed of and involved in the complaint resolution process. The Grievance mmittee reviews and, when possible, resolves complaints from the patient served and hie Jr her family. The Grievance Committee acknowledges receipt of the complaint and noti?es the patient served and, when appropriate,'his or her family of the outcome of the complaint. Bach fee llity provides the patient served (and when deemed bene?cial, his or her family) with the phone authority. PROCEDURE: A. Patient Noti?eatio 1 The Feel lit}: will g?evances end the number and addIeSs needed to ?le a complaint with the relevant state orm patients, in writing, of their right to make complaints and process to do so the registration/admitting process. 13 . w" - - fu- Hm-umuumm B. Patient Complaints I. Staff shall enoc patients to express any complaints or concerns to the individual involved and atgrji?ist a resolution. 2. If a resolution owner be reached, elientw?l ?ll out grievance form. Patient Fennel Grievance I. In advance of f1 .mishing care, all patients will he noti?ed of the right to submit a - grievance and to whore that grievance should he submitted. - The CEO or dot ignee will receive all grievances submitted. All complaints not resolved at the deparhnent level or if the patient is not satis?ed will be forward it! to the CEO via the Department Head. 3. The ad hoc 31ievanoe Committee will then he conirened. b. This committee shall consist of a member of the Clinical Department another member ofAdministratlon and the patient?s treatment team. 4. A?er diseussion Committee. The taken to iIIVestig 5. [tithe event that CEO or deal 6. Time Frame for soon as possihl 7. Time frame to of the next has provided withi . a. - The name h. Steps take .0. Results of d. Date of res 8. Weshninster wil facilityr to monit 9. The noti?cation the fact that the regardless of wt telephone numb with the patient an investigation is conducted by the Grievance patient will receive a letter ?om the Administrator outlining steps ate the complaint and the results. the ad hoe Grievance Committee calmer agree upon a decision, the will become involved and render the final decision eview: The review and investigation of a grievance will take place as after noti?cation, and no later than the end of the next Business day response: response to a grievance will he made no later than the end ess day after the complaint is A mitten will be the next two business days and will include: the Westminster contest person; . by Weshninster to investigate the grievance; grievance process (Westminster ?ndings); and lution of the giievanee. I maintain a ?le on all grievances and their resolution to enable the or compliance with this policy. to patients conceming their right to submit a grievance shall include patient may address his or her concerns to the state survey agency other the hospital?s grievance pro seas is used. The address and or of the appropriate agency will be provided is writing to the patient. 0T1 RIVA This notice describes how nedieal information about you maybe used and disclosed, and how you can get access to this info ation. Please review it carefully. Westminster is required by law to maintain the privacy of your health information and to provide 14 yon with notice of its legal duties and privacypraotieea Wim respect to your health information. Effective Date of This I. tice: annary 3, 2816 How Westminste may Use or-Diaclose Your Health Information: Westminster cello to health information ?om you and stores it within Weahninster as your medical moor-f1. the medical recon belongs to you. Westminster protects the privacy of your health information. il'he the followhlg pulp 1. . treahnent, or is order to coord re: Treatment. If authorization/c infomation' on. diagnosis, phy treatment at Vt may involve therapy is a calls may also you or in situn results that car medical record is the property of Westminster; but the hwformation in another treatment provider has previously been involved in your going to be involved in the micro, we may Want to discuss your case in inate care between us, however, this will only he done with written onsent ?oor you, or in an emergency situation. The kinds of health care a may disclose about you in such circumstances could include your sieian assessments, lab results, progress in treahnent, etc. During your 'estrninster you may also be introlved in group therapy. 'Ihis technique ldely accepted and often bene?cial therapeutic. tool. Followup phone be done after treatment, however only with authorizationfconsent from 1e back. after your discharge.- Pawnt. If treatment do on are covered by health' msuxance, We may disclose diagnostic and to your inmnance provider in order to obtain payment for services rendered If are assisting you in applying for health coverage, such as Medical Assistance, may need to disclose pertinent information, such as wo?r history, in order to meet Regular Healt agencies who ligibillty requirements. 1 Care Operations. Your medical record may be randomly inspected by conduct quality assurance reviews to ensure that high standards of care are being maintained Noti?cation a an emergency a family me care about yo emergency sit family or para or object due hestjadgment Remixed-b: 12H id communication with family Only with authoriza?onfconsent, or in may we disclose your health information to notify or assist in notifying tor, your personal representative or another person responsible for your location, your general condition or in the event of your death. In an lotion, including if you are transferred to another facility for medical or anal representative. However, if you are unavailable or unable to agree medical or reasons, our health professionals will use their in communication with your family and others. w. As required by law, we may use and disclose your health information. 15 aw permits Wesnninster to use or disclose your health information for ?scussions of a personal nature within a small group setting. Group lions where We must follow?up legarding health concerns? such as test teens, we will give you the opportunity to object to noti?cation of your -. - or missing 10. 11. 12. 13. 14. 15. 35. Pnhlic health. its required by law, we may disclose your health information to public health author-hit for purposes related to: preventing or controlling disease, injury or disability; repo ing child abuse or neglect; reporting domestic violence; reporting to the Food and Drug Administration problems smith products and reactions to medications; reporting disease or infection exposure, such as HIV, AIDS, hepatitis, and tuberculos' These disclosures are done In a con?dential manner with only the minimum nece my information provided to required public health authorities; I activities. We may disclose your health i?formation to health eigeacies of audits, investigations, inspections, iicensure and other proceedings Judicial and ad nioistraiive proceedings. We may disclose your health information in the course after adn?nishative or judicial proceeding. at. We may disclose your health information to a law enforcement 'sos such as identifying or locating a suspect, fugitive, material witness on, complying with a court order oreubpoena and other law ses. - enforcement Deceased cars 11' information We may disclose your health information to corona-rs, medical exam?em and funeral directors. Organ donatior. We may disclose your health information to organizations involved in procuring, b: inking or transplanting organs and tissues. Public safety. We may disclose Your health ihforination to appropriate persons in order to prevent or 1e seen a serious and imminent threat to the health or safety of a particular person or the mral public. Worker?s corn ensation, With your authorizationfcons eat we may disclose your health infermation as ecessarj,l to comply with worker?s compensation laws. . Marketing. may contact you to provide appointment reminders or to give you information a at other treatments or health?related bene?ts and services that may be of interest to u. Chance of Ownership. In the event that Weshninster is sold or merged with another organization, your hoalth infonnationfrecord will! become the property of the new owner. Business-Associates. There are some services that we need to contract saith business associates for, such as consultant and attorney services. When these services are contracted, We may disclose yorn' health information so that they may perform the job we've asked em to do. To protect your health inforniation, We require these hushiess associates to a propriately safeguard your infonnation. 15 When Westminster May Not Use or Dis close Your Health Information Ettcept as described inthie Notice ofPrivaey Practices, Westminster will not use or?diselose your health infoohetion without your Written euthoiization, If you do authorize Westminster to use or disclose your health information for another pmjpose, you may revoke your authorization in writing at any time. Yo or Health Information Rights 3.. You have the ri to request resnietions on certain ones and disclosures of your health . information. Westminster is not required to agree to the restriction that you requested. 2. You have the r. .ght to receive your health information through a reasonable alterne?ve means or at an alternative location It is the policy of Westminster, however, that all . such requests he put in uniting.? A reasonable fee will be charged for cepying your health informeion; 3. You have the right to inspect and copy your health information. However, it is the policy of Westminster that each discipline sits doom and reviews their notes with you 4. You have a rightto request that Weshnineter amend your health infonnation that is iueozreet or incomplete. is not required to change your health information and will provide you udth infomation about Weekninster?s denial and how you 9311 disagree with the denial. . -. 5. You may request that we provide you with 21 Written accounting of all discloeores made by us during t?1e time period for wl?eh you roguest (not to exceed 6 years or for any date prior to A pril 2003). We ask that such re quests be made in writing on a form provided by 11' facility. Please note that an accounting will not apply teeny of the following typee of disclosures: disclosures made for reasons of treatment, payment or health care operations; disclosures made to you or your legal representative, or any other individtt ll involved with your care; disclosures to correctional institutions or law enforcement t?oial's; disclosures for national security purposes, and disclosures made with Mitten a1 Itho?zationfconsent. You will not be charged for your ?rst accounting request in any 12~month period. However, for any requests that you make thereafter, you will he charged a reasonable, cost?based fee. ?For more information about this right, see 45 6 . You have a rig lit to a paper copy of this Notioe-of Privacy Practices- Changes to this Notice of Privacy Practices . . - Westminster roses ves the right to amend this Notice of Privacy Pmotioes at anytime in the tonne, and to .hieke the new provisions effective for all information that it maintains, inoluding informa than that was created or received prior to the date of such amendment. Until such amend nent is made, Wesuoinster is :equired'hylaw to comply with this Notice. Should our privacy practices change, we will provide all current end future patients with a 17 copy of the revised Notice of Privacy Practi?es. V. Complaints Complaints about infoma?on shoul he directed to: Diractur 0 Quality Control Compliance . Recovexy enters' of Amegrica sanee" Boulevard ssia, PA 19496 If you have any mplaints?about the s?rvices you have receivcti. Bureau 0 substanca Abuse Services Departm of Public Health 250 Was gton Street Boston, MA 02108-4685! Phone: 62 Confideni in! Complaint Lines Phone: 6 i7?624-51? Fax: 617?1324455919 You may also address yo compliant to one of the regional Offices for Civil Rights. A list of these: of?ces can be foun online ai QUICK Gmm'To MEDICATION ASSISTED THERAPY (MAT) Medica?on?Assisted Tharapy (MAT) is de?ned as the use prescribed and monitoredlby a physician, to support weaver? from a Substance Use Disorder. - Bcge?ts of MAT i?clude: 18 Notice ofP?Vacy Practices or how Westminster handles your health ad with the manner in which this o?fice handles a complaint, you may Naltrexone Vivittol 9 An important tool hoannont to be combined with counseling, peer support and 12~ Step program Redness tho ?equoh Decreases or block: Provides a defense: Tho only oral medid dependent co Naltro'xone works a Naltroit'ono reduces offsets . Will not make you of them, such as ini cy and intensity of oro?ngs the strperienco of feeling ?high? or intoxicated mechanism against impulsive use i i 1 :ation approtied to treat both alcohol dependence and Opiate an opiioid blocker, preventing tho toward of getting high. the urges to use alcohol or othor drugs, and reduces their ploasurable sick if you drink alcohol or use drugs, and will not reduce the effects paired coordination and judgement Naitxoxono does not provont the good feelings from naturally pleasmable activities Starts working 1-3 The longnlasting in 0 Lasts 1 mo] 0 Preformed II medication 0 Cannot be 1 Side Effects hours after taken and stays in the body over 24 hours ectable formiof Nani-axons is Vivitrol (approved for use). L?l per injection othod because it does not reqoiio the patientto remember to take the manipulated by not taking it if a patient has the urge to use 0 Commonflx lildf?l?omporaxy: Fatigue, nausea, handsoho, dizziness?nsomnia, tendemoss 0 Loss Co behavior, Precautions 0 To avoio 3 14 days he mayreq i113 notion site OEMOIC Serious: Liver toxicity, depression; suicidal or jeotion site reao?onw?sometimos serious and needing ddon opioid withdrawal, the patient must be clean from opioids for 7.. re starting anttoxono. Sudden opioid withdrawal can be severe and hospitalization. 0 Do not try 0 ovorcomo? this block by over-taking largo amounts of opioids. This can lead to 'idontsl overdoSo, serious injury, toms, or death. 0 Naltroxon is not pain management. Patients will still ?ood an altomativo mothod for pain Supp ort- Network 0 MAT reg that the pa 0 Supports gems-st. a strong support notwork, including. someone who will make also out continues to take their medication regulariy old know the precautions of MAT I is MAT and Recovery Proloxlged use of alcohol and other drugs can change the way the brain is formed and structured. MAT eatment and posi?Ve coping skills can he used threughout treatment to restore and tab we: the brain?s structure. Committing to Vi itrol can save lives; The rate of oVerdosing by continuing to use heroin and other ioids is growi?g on an epidemic level. The rate of relapse 011 these . - substances is . MAT for the ?rst so to 90 days of mum: can "add support When conventional metheds of recovery alone are not enough, MAT may be the missing Receiving the Viv 'tml shot prior {0 discharge from in?atient treatment is highly recommended to I ?ip prevent the?high likelihood of relapse. Individuals who used MAT had relapse rates 5 0% lower than those not taking anything. Thus, had emuch better chance at long?ten 31 recovery with MAT. link Helps patients live a life free ofpain and manageability of alcoholand other drag addiction 20 Clinical Use qf Extended-Release inlectable Nal?exone in the Treatment pf Ogold U33 Dlaqrder: A Brief Guide TABLE 1: KEY FEATURES OF MEDICATIONS APPROVED FOR TREATING . OPIOID USE DISORDER . . ?Mu-??ily- . . 'Admlniztra?on Rm Ir?ltr?nmbular (1M mj?mm th'e glared Orally as liquid megawatagiamt or oral I . (brambles: or?lm is $53131de under the tongua. - Who Harman-the or Any lndeuai .whu ls ?nanced to We SAMHS?rcenf?ad OTPS dispanuh mamadma Physicians must have-W11 codi?ca?an If; Dispense medicines! -u Melan. :21me for dairy- adminiafr??m either an aim or; Var ?d?tctisq matildna or addiction Main; audio;- assiatei?t, Hum prab?tiorzsi'} may pre?m?he atabie p?a?an?ts. at '.homa mmpleta' spacial talr?ng to qualify for mama: andzardrder by maimed staff. Waiver to prescribe but any phannaay can rm ma prascrip?m. . mare we no speciat requlmmenhs fursta? members who dispense bupranorphina supervision of a wavered thhyalcnan. Opinid partial - Buprahorphine?s Ra?-qr effect talisman w?hdm?: syn-nuptials faulting cassa?an a! T1113 same a g?acuta Mtlidraw In The presence. 01' hog-swam aphids or Huffman: amounts of moaptcr- bound full Egon-Tats. Na?uxnne, an aphid antagonist, Ia s?ma?mwaddad 1b. to make me precinct lass Ilkaiy :9 he abus'?d by Madman. Pimmncoipgic Opium antagonist Opioid category 791313 ?1 3mm WW 91??:me It dim mt pmfda compiblo Non-nano?md is not Estimated asasubsumt? package Imartsror mmrencagopmas mud . wj'or 01mm Wage Enamel. For patieriylnfama?on ahaut these 313d other drugs. visit the ?aglpnal MadlnePlus . W?am?rr a?madlcai?an amuld be present-Jed and In ?what mom! are (113th to ha'dmhd batman an and 11:5 ur prmd??r T?a mam-lbw hufumatl'nh pzbv'udad Hera-F: act a summer For the dhioi?n siu?g?r?nant, and! the?: Na?qnal in?Maa cf Haal'?m and accept no ?ahm'ty-nr womaniztyfur orb-1'3 lufanna?an In the were! Indivi?u?! patients. I Nalknemmr momma 133161: {50 m1: each} 3113 also swam for daily dosing. pnsmierqhuyl?. Clink??'uhes?daaf' Candidates I vaen?c'rr ?f-r?l?ps?t? 5353615 dim?- [lowing opiqlc} dqtoxf?ca?cmstudfaa- suggestbene?xafotpauanta are expe?emlng increased stress or ather ralapsa?aha (agq visib?ng graces af'prevlaua drug use; loss of apmsa, 1:133 ofhb}. Appropriate {oi-patients whiz hav'q beets-L dammed a??da and wl?t?aam being treated fora mmr?ug 31:01:01 use aphid addiction. a ??ca?nn thatnentm Pa?ents whc'ara motivated in adhara t0 the treatment plan and who have no contraindica?cns to mamadone?terapy. Me?iadma should be ??i?iiripiudas 41m attended-release naltramneshoutd he pad (if a. comprehemwe that inclu?m 0mm Quad Qandidates. Include: persons with a . Shoat-or l?s?segereiadgj?clion hi?w armh? must demonstrable Ibfiaaslpn'gl ?ce?si?g bqavda'pr Grin-anal jus as of?cials that their r131: use [5 low, ?rmnn?' Tremanfofopiold dependence. 'Patigrim who are motivated to adhere to H19 ?eatmanf. plan and who ham mounti'amdlaa?ons tn iharapy. ?hauld be: part of a . 'minagaml? program that tnqludes psy'ch?aadal . sappmt. Cn?tx??inpilca?ons G?g?t'alnalig?tgd ?a?e?fs mbgl?nd kang- Ca?htal?dichtad in patterns whu are engaggd- in cutter?Ri-??inid usa?gas Indlcatiad by: self-v reportnra positive urine. drug screamm who are thuprenomhin's oz'mathadcne mairiianaf?oa??z?ra?ws aawall a9. In those camel-111? Cdi'atraih?cateq in pgtlents W?h 'a Estuary-of smal??tyiapcl?an?degm?ycallde. many :gmponama. of the dnirant. Shculdmk be ?rm to? patlenta whose boa}! - mass pradudeas'lM Injection with the 2-inch 11581113 provided: Inadmr'iant aubwbana'ous i'njeb?pn may maa'? sava?ra Idlec?on site reaction. .52th nqtbe given to anyone ails-rain to nakmxona. Qs?mtrain?fbatad Izi hy??rsan??lve in ma'thaadnna or artyjother Ingre?i?m-in methadone 'hy?mchlodda tablets. diskettes, powder or liquid abncenh-ata. contrabmlcatad' In patienra . depression-{In the. abgenca-offaauahira?ue equipment gr In unnm?org?egttings) andih pa?qms With acute; Ibmadhhbaathma .ar hyparwbia. In any patieqt who has or 15 - suspected of having a paralytic Klaus. Santana-mama pa?enta? w?a ara'hypamqnsithga bpbuprencrg?lne pr'naiog-zone. .22. 1.32:1:- Farmsitler: Warnings . wastage,- moderate to mm renat impairmant. ?ndmamm of w?dbaarhg agar. Discontinua In the eventuf at- signs at acute hapatili?. A2. with any EM injection. amndegt-raiease ahnmd be aged wIlh caution in patients with mromhowtopar?a or any naagula?on disarm: hemophilia, savmhapa?c {allure}: such pattanta should . be timely Worm for 24-hour; a?ar aided): anti panama wl??t head in}ury. or bummed Intiam?ar?iprastsuh; patient; whom know to be 331151th ta cantatrmmusayatem?depressanm. sum as .?'msa with cardiovascular, putnonam renal. or hepatic disaasa: and pa?anta with comm-hid . commons Bf concomitant mdktet?ons that any Matinee Lg reduced seawater? tim. . {de?nitions should be administered m?th cautiun ?1-31. ?mtg. Patients may became'sansltive to tower .dm of optoig? after iraalmant with . extended-i?eteasa- injectabla This maid rast?tlh pot?eh?a?y ?fe-Hmateting opIttId intoxication and We 11' pmw?ou?ly total-elect lama:- dasas are might-ad. C?nictansshut?d warn patrents that ovar'dosa trying towel-cam tha ppinId ?ocked: affects of n??eomm. .protonga a ford marttof mam at Banana a _m a. The herbal Minds: 3 mama about madman that may pmdude driving or spam?ng aqu'lpmant. - noun-red lnamoia?n? I Bupmnorpl?tta may pmulgitnta wIthdrawat ifint?atad may precluda driving uraperating .squtpment. Caulinn ?9 ragutrat?u preac?hm Pupremmhinato use and than: who have 3am hapallc lmpahnmt. campromlaa? 'tasptratmy ?inctlan, at head Injury. anddetath have par?culariy administered lmvemuely or in combination with banzodfazapinas na- othar tantra: mamas wsiam (Indudlng?lcohct). . heifer: paihmtis In particutariy in . 'ma tabs! Includes all-mm about madame that - Use in Pregnant and ngnancy?.? FDA megawatt catago 9? Postpartum Wan-tan Transfer o?nalttr?emna and nalh'axol Into? human mm: has been mportad with oral Mime. Em at?znal atudtaa have mattrexona has patenttat for Mn?ganidiy and other serious ache-m nursing Watts, an maiw?ita?zed . mm decision 5110ng be made: uthath?ra. naming mother MEI need ta discontinue breast feeding a: die-continue nti?mxune. Margo}: FDA gragnancy category 0* . Mathadon?a has been used during MW ta 91'0th form thana?ta ygam Neonatal abstinence mayocmr In ?aw-thorn infants of mbtham who remind methadone during No Iai?ni ham-t mitts fetus has baht: as a result" cf $115 therapy hilt Indi?dua?zed?traahrmt decisibns balancing the?zk and bena?tsnl? therapy shantd be made w?h each pregnant pa?anf. Naratrtg: manta malntalnad on methadone can ?masthead if they am not HIV posltive: are notabuahg aubst?nm. and tin-not have a dlseaae m- Infection In vmich bmastfeec?ng Lo; . - Pregnancy: FDA mgnarxoy categmy 0? - been 23$ 3. thls'??ler?psr but . Individualizgd Ewan! decisions balancing 1113 ?ak :pregnant patient. Neonatai aba?hanm uyndrama maximum In Infants who maelvgd mediates-assisted na durtng pregnancy. No lasting harm to the fetus andbena?ts of therapyshat?d be made wim? Bach Bup?renot'ghgna and Its metabolite present In 19w mats in human mic-and data are tinted but have: not 'shawn advansa reactions In . bmas?ed Iniants. Fatan?gtt tiarAbm and No Yea Yea amtm sometim?m" ?4 23 Animal stuck; ham stud-m an 'adverab e??ect the talus and them are no attenuate. studies In humans. but natal-mat bene?ts. mav warrant-ma cf'lha ctr-uh In mama mam-mm You are not alone. Tl1e fo 1) ENG THE SIGN. PREVENTION 0F SA VE A LIFE. Signs of opioid oven! may include: - Broathing that IS slow shallow or no breathing at all . Very sleepy and not 1' pending to your voice or touch Blue or grayish skin 0 lor with dark lips and ?ngernails Snoring or gurgling uds - If there are I an overdose: Tap, shake, and shoot . is still on map: It?no or little respoose Opioid? include: heroin morphioe, oxycodone 2) CALL 9-1-1. 0 An Opioid overdose ca (Nam) can reverse a When you can 9-14: Give the addrots Tell them it?s an overt! use: so they can bring naloxono {Nara-an). Or say; ?My friend is not breathing. tthe person to get a response' Ease, rub knuckles on the. breast home @1911 codeine fentanyl, hydrocodone Woodm), hydromorphone OxyCon?n, Percoqei) etc, VERD 05E IS A WIEDICAL EMERGENCY. cause a coma or death within minutes. A medication trailed naloxone overdose anti save a life. 31- . Stay with the person; The 94-1 Good Samaritan law provides protection ?om most and prosecution for drug possession. While you wait for the Do rescue breathing. ambulance: Give (N area a) If you have it If you ham: to leave t1 6 person for any amount of true, place the person on their side Tell the ambulance can about any alcohol or drugs ikepemm Imus takem If ya 1: cam: 02? sfoy, leave d' 3)]90 RESCUE BEE note with the informio? 4THING IF BREATHING IS SLOWED OR STOPPED. I. Make sum nothing is in the mouth 2. Tilt head back, lift shin, pinch nose 3 Bteatho in mouth once every 5 seconds GET THERE IS HELP. lowing resources can help you ?nd substance-abuse treatment, prevention services, and information. .24 Massachusetts Substance Lbuse Informa?bn and Education Helpline . Free and con?dcn?z infanna?on and referrals in public and p?vata treatment programs . - Health insurance: may not he requimd . ava?abl: in 149 languages free Law?327 5050 Sta?'ed 7 days a we WY: Use MMSRE at 711 or 1-800-720-3480 MaSSachthetts Overdose tevention Resources Free and con?denti training on preventing, and responding to 15 Includes rescue breathing and how to 1336 naloxone (Narcan) over 140 Inguages. acorn Far information ahaut available overdose mama visit s_e_ 25 Continuing care oblectivesr limo; Gamma Title: Continuing (tars Planning Effective Date: March 201.6 - Manual: Related Department Policy No: 1007 'ReviewfRevislon Date: Page 1 of 2 PURPOSE: The purpose of this policy( is s?tthe standards for pro?discharge assessment continuing care treatment planning; contin ing care treatment provided and followup requirements from accepting agencies, facilities, or indiv ual's who provide treatment POLICY: It is the policy of sorrow Centers ofhmerlca (RCA) to have as an integral part of discharge planning, a continuing care assessment and plan that address the needs, preferences, and goals along with the individ all physical and needs to support recovery post discharge. 1. That each patielnt discharged develops a plan for. continuing'care, in collaboration with the treatment team. 2. That the prime of objectives to poet~acute carercontinuing care plan are to enhance healthy growth and de?felopment in all functions or the patient?s life, and to prevent relapse and re? hospitalization for so ostance abuse or misuse. . 3. - That there is a :ontinuity of care {hand off} to an outpatient treatment modality that will Incorporate im olvementin appropriate self?help programs. intensive out?patient program, continuing can: group, and/or continued individual out?patient professional therapy. I 4. That patients naquiring additional stroctured treatment he transferred to an extended-care, long term, alternate living, or like, facility for continuation of more intense therapy. 5. That each patient shall be followarihup for 12 months atterdisoharge, to determine the progress of the Continuing Care Plan centinulog recovery. The continuing care plan is prepared with each patient. Although discharge planning is begun at the time of admission, the continuing care plan will be developed over the length oitreatrnent, and its ?nal components are based on he latest assessment of the patient, the patients? needs and preferences. The treatment team, with he patient?s active participation will tormulate the plan with the patient and each member ofthe team signing the dooument The treatment team, director andlor attending physician will make ?nal decisions as to transfer, therapeutic modalities; and prescribed treatment The patients? designated there ?st and care manager will be responsible for coordinating all aspects of the continuing care plan. Outpatient Options 1. Outpatient treatma nt may consist of individual or group therapy, or both, and may include the patient?s family members! and other signi?cant persons. in the patients? recovery. '?tle: Continuing Care Planning . Policy No: 1007 Effective Date: March 2016 Review/Revislon Date: Manual: Clinical/Outda?ent' Page 2 of 2 Related Depemnen??]: 2. Each p-atient will he trongly encouraged to become actively involved with a self? help fellowship, and to a empt to become Involved in lz-step recovery program. Patients are encouraged to attai a "sponso?' prior to Discharge 3. The attending an (if applicable) may de?ire to continue to see the patient on an outpatient basis. Pa 4. Patlents referred to back to that person treai'm ent.? Reference: ants needed additional oversight of a physician. RCA treatment by a or other licensed therapist will be referred llpon discharge, whether that person was attending or not during TIC CTS 05.02.01, 05.02.03, ?5.03.01; MA 105 CMR 164.040; MD 10.47.04; NJ PA 709,53 1 are . I I i I U-IIRecovery Gamers af?mo?m Ad'misslons and Exclusion Criteria RCA heats adult males and females who are 18 years of age or otder and have problems resume from addictive disordaze. it is the policy of RCA to admit patients for regard to gender, race, rellgion, matinee} origin, ma?tel status. creed gender identity or same} orientation. Patients may also be admitted with and will be - heated for mantel health illnesses. All admissions are expected to be voluntary and prospective patients must make a verbal aha give wetter: consent to oompiete the diagnostic evalua?ods and be invoked In treatment. The decision to admit an individual ?es solely with RCA. REA 13. not bound by any contract or other oh?getion to accept an individuat Into treatment who Is inappropriate. by virtue of medical or peyct?at?c diagnosis. not a category of automatic exoluemn {Fiat 13 de?ned by a hletory of criminal! conviction In addition-f, per CMR RCA shalt not deny admtesion to an individual eotety because the Endmdual uses amedioe?tion preso?bed by a physician outside RCA 3 service or facility. Some patients will be excluded 1mm admlselon to our lnpa?entlres] ?en?al programs. He potential patient meets any of the criterle listed below, then sihe may not be admitted to RCA Inpatient programs biased upon further screening under the age of 18. - individuals euttering from a ounentty unstable oorzd [tion that requires a higher love! of payments care. This Includes but to not limited to: persons exhibiting active of schizophrenia, behavior, active suicide! Idee?on with a ptan, endear active suioldel thoughts at which the pe?ent cannot contract for safety. Individuals who are bed-?dden. unebie to participate in deity programing andfor unable to take care of their Activitiee of Daily Ltving L?e) - Persons suffering from a medical that to notabie to be addressed In this setting. General moms Nonheeoltel Datamation Program mission Criteria Nontmeoltol Rwidon?al ram Admission Criteria - 1. The Intake will 1. from either the DSM 5 'Addlc?om 1. Hate must meet the mm 5 ?Addictions a Rotated Disorders? or 1130-13 outlook all emu information from the potential patient. smeared momma" mutton or ICU-10 ?F?eyohoao?va Substance autumnal: Use DIWdH?Dapmdanm' as wall as odterla for this level of 2. if the paten?at patient to corral-my In mother facility or Use Disorder-Dependents" ae weit as ASAM o?tada for thleievet oete. emergency clinical dommenta?m eel be of care. 2. [ntmdoztton requested {or review The RCA medical can also 2. irdoxica?un ?Withdrawal Individuals about! also meet ONE ofthefenowlng: speak with mummy orED provider . tndivlduate should also meet ORE oftho mum: a} The led'widunl is messed as being at minimal to no risk of withdrawal as 3. obtain mitten emanate-am the potan?ut patient a} The risk of a severe ?more?! to present but evidenced by: to mt?dpetem IIyln dream?oavalua?on and treatment. memeebin' thin netting. as evidenced by: (1) EMA-9R 1(0th mum Wham Assessment? ?Re'rtsad1 score (at 1:511 Br 4. RCA w?I provrde referee! option: to who are Individual Erma alcohol and {minted comparable atmderdlze? swim system) often than 10 fattening a home of abstinence from madr?ttad'?orany mason meme Withdrawal Assessment- Home Revised} score {or Worms: medloa?m OR standerdizedeoodng system) equal: 10 -19: OR (2) Blood otoohot 3.091111% and withdrawal ell-gee or syn-tom wt?ch wire Daily lngas?m ?f sedetlsre hypnotic: or 0131::th for our eh: madlutlon: 0R ?ml-rs, medalist nee ofano?termH-xi-alterhg drunlmomto have Gib-amt: of protracted m1 which. If present. can he managed refers: "3 9!?de mam-emu (dam 11511?! menito?m' an Mable. wlmout dolly managed interval-[Hem heeded) with no chronto disorder with withdrawal no more severe than meet: noted In Bactlon? that mid mama-Mutant OR the Indeuei has and menu-1d; positively to. emotional slipped and comfort as evidenced by (3) Dolor Melton at eo?a?m hypnotic; or eplotds above the wot-em by the and afthe inI?eI metm recommendedmarepw?o dosage level foratleaet? maimoloee 3. Biomedical Conditions and Gomptloa?me hourly monitoring in available, if matted}, Width no ehoul? moot ONE emu fdlowlna: chm: maanhySIoaI moor-1r. OR 3} Continued use place: mdh?ouel In poeslhle danger of narioue damage to (4) The meme: neon high duets of one! andior new biomediod omdt?ons 9. continued use ofetoohol deeptte S?mmanll. e?muimteetlomtonoe a day dt nests armor mate of diabet cirrhosis of the liver vat-estate m- eetmree durtn 2701 Rene Essence Blvd. Floor, King of PA 19495 nu Em. . Recovery Somme af?rmation d1 acyclic patient of' runs: and is manually within 7 days ufeuch drug use: DE (5) The individual has teamed lethargy. hyper commence. or levels: agitation modeled with Hammad high degree: of 3. Biomedical Cmdi?ous and Complications hdlridmia abated also meet the e) Gen?med elmholidmg use planes the individual in imminent danger of new: emerge to premise! health fer hlmedlcai mnditima B) compilee?me addiction or a emeueeni hirer-radical lli_nen require medical but net Irrtemilie we. - - mf?cien?y interfering with abstinence, rewi?w and stability lathe degree meta structured 24? ueniin 1nd We use deepile history of seizures emaciated with end-f? use. high bleed pm cr ear-dimmer er :3th pmhieme, or continued elemdi?dmg use within a sell-deetrue?mlifeeiyie while HIV-positive er AIDS-emkxmilc); b) Biomedical complications e? addiction er ammn'emt blemedleei illness reql?re medical mar-altering heme! mam we iee. AIDS-empteme?e cl Eir?lvidueI' :3 pregnant. cen?nned or returning elm eii?dmg nee would place the teens In laminae: danger of temporary as: timer-suit disability: cl} The indiviriuel?e biomedical mpileeliene are not me enough fer Level: 3 or 4. trulere su?lr?'enl 10 recovery efforts. Such require medical menlterleg. neuter be heated by a concurrent anal-lament with another treatment pm?der. 4. Meeii?ehevieml Dendi?ene and (implications individualsehmid also meet the farming: a] Depression endioreiherametlmerbeherloral eempulaive behaviors} are hr m?mmnl is need in edema: and Wallets; b) There leemoderale rink (Usuallymenifesled hyiighiydysi?mdienel barbaric: in instalment pail) efhehevier: endangering eel)? or ether-e euteidai or honiddel with no eetlve plan but a matte? efeeicidel gestures enquiries Hiram): recalling; individual item this environment; a) Thelndivlduei le manifesting stress adieu-tram related in meenter ?ueatenee leans lathe won: ammo: ?er-?Jr 1 skewered eem mv'manme-e i: needed lie help tile lndM?uei hlefller ad err, - d) Gerlcm?tem personality disorders lee. an?aecial disorder wiih verbal aggressive behavior requiem constant lime-selling) are crunch severity dyn?mclimei behaviors require boundary-?semen lnlewm?ena. 5. Readiness to Change Deepile eemcensequencee mdr?ereil?ecie ef'the attention en the Individuai?e life (a my health. family, work, or genial prairie-en}. deseneleccept er reieteie Ihemetmr of?ine emblems. The individual Mn need :ilntenslVe milk-elm: strategies activities, and presence enly available within it e. mime Pmarmal . individualism meet ONE cf lizaiellawlng: Despite a history cameraman: episodes at lees lntenaive lelret of care. the mdhiduel IS mmlmeieg en ewie' emit with a cenmilent hienei?cetien ef addiction wmpteme leg. dl?leulty [amt-Lu e'm??ceiien end related drug-?seeking hammer; in) The in?iuichai is med 2: he Indmga er rid-lime a: dragging with euehdani eelrere mquaneae. and is need 1124 waned-term prefmlmely directed clinical [Wen?m e) The individual drug use is excessive and he: attempted in reduce or main. hut has been unable tedo en as lung. 33 alcohol endler drugs are prurient in ?wheel-um - 7. Raceway Envimmi individuals should meet ONE tithe following. a) The lives in eevlrenmenl: (lag. Beale! or lr?erpereeml network) In which treatment is unmet tn aueceerl leg. family full cf interpersonal cen?ict which melamine: individual'e after-is in change, family membem when living with the marital current substance abuse pmbleme and are fricely to meantime the h} Logistic impediments distance item Irene-11ml facility, Inability Immature, lack e? driver: ices-lee, .ebe.) preclude pariidpeiierr' r: been-neat services at a in: level. c] There is a danger of phyeicai sexual, undia- eevere emotional am er vitilmlzeiion' the Indhadual'e cum: Bnei?mment whleh will melee maven: unlikely eminent ramming 1115 cl} Individual le etiquette en mime. Wit? {es elminel activity euppert habit} er newpe?nn We mllnued ended endier drug nee 1118 part elf the Individual commutes etlheien?nl imminent risk in public at pummel ?My {3.9 in?l?duei la. airline plinth bus clever; [Elm Em Recover? Chums l1i? America police denim nurse eenelrudlen werlcer. aim). i 2m Reneiesance ewe, 411h Finer; King ofPressia, PA 19406 Case Management and Counsefor Schetiule RCA-Westminster March 1, 2017 March 4, 201? 4 I . ram-n Wednes?av?13??ffhui?5?3f . -- Saturdav ?zso-Spm 8:30-5pm 8:30-5 pm 8:30-5pm 8:30-5pm 330-59111 8:30-59:13 3:30-5pm 3:31:3?5 pm 8:30-5pm 8:30-5pm 3:30-5pm WW ?mam? 830-ng llam-me 11am?7pm 11am?7pm Cnunselor . . '103m-130prn 9:00-5:30pm 9:00-5:30pm 8:00-4:30pm 8:004:3me 8:00?4:309m 8:004:30pm- 8:00?4:30pm intake Counselor 3:00-4:30pm 8:00-4:309111? 10-5:00pm March 5, 2017 - March 11, 2017 WM 1&5} Tugs?a?a, . Thursday _r 3:313} 5.?S??ig??ia9l} Clin. Supemsor 8:30-5:33? 3: 30-51311?: 3:30-5pm Counselor . 3:30-5 pm 8:30?5pm -8:30-5pm Counsetor 8:30?Spm 8:30-5pm 8:30-513 8:30-5pm 8 Counselor 8:30-51 pm 8:30?5pm 3:30-5pm 8:50-5 pm Counselor 8:30?Spm 8:30-5pm 8:30-5pm 8:3 0-5pm Counseior 113 m?7pm {Liam-mm Ham-7pm. 113m37pm . name'r'pm A..- Counselor Ann.? IO-iimlpm Counseior 8:30-4pm Clin. Director 7:00?5pm ?:00-5pm ?:00~5pm 7:00?5pm 7:00-5pm anmTme Case Manager 9:00-5:30pm 9:00?3:30pm 9:00-5:30pm 9:006:3010111 9:00-5:30pm Case Manager 3:00-4:30pm 8:00?4:30pm 8:004:30pm 3:00-4:30pm Case Manager 8:0Q-4:30pm 3:00?4:30pm 8:00-4:30pm 8:004:30pm 8:00-4:30pm 10-3:30pm Intake Counselor 9:30~5:30pm March 12, 2317 March 18, 201?? . .33; -: - Wan Lia-?mw?sdav mgrdavi" - Clin. Supervisor. 8:30-5pm 8:30?5:31: . 3:30-5pm Counseior 8:30~Spm 3:30-5pm 3:30-Spm 3:30-5pm 8:30?5pm Counselor ?gs-Sm 8:30-5pm? 8:3 0?5pm 8:30-5pm 8:30-Spm Counselor 8:30?5pm 8:30-51:17: ago?slim 830-5 CounseEor 3:30-5pm 8:30-5pm 3:30-5pm 3:3 0?5pm 8:30-5 pm Comseior 11am-7pm llam?7pm llam-Tpm llam-7pm 11am-7pm MU UK ?map-? I: Ill (3 1115151-?! Counselar 3:30-4pm 61in. Director 7:00?Spm 7:00~5pm ?:00-5pm 7:00~5pm ll-Spm Case manager 9:00~539pm 9:00-5:309m 9:00~S:30pm Sim-5:301:31 Case Manager 8:004:3{me 8:00-43 0pm 3:004:30pm 3:00-4:30pm awe?mom Case Manager 8:00-4:30pm 8:00-4:30pm 8:00?4:30pm 8:00-4:30pm mm 10%:00pm March 19, 201? March 25', 201?? Man a. 'ulf I. . q, hug?: Wagn?redi Fndav -1. "visatfara'ay .. 1.. .. . - ndayem-z?. the. .u . 8:30-5pm 3:30-5pm 8:30n5pm 8:30?5pm 8:30?5pm 3:30-5pm 8:30-51:31 a:30~5pm 8:30-Spm 8:30-5pm 3:30-5pm 8:30-5pm 8:3 0-5pm 3:30-5pm 8:30?51:11?: 8:30-5pm 8:30-51:17: 8:30~5pm 'Bza?-Spm 8:30-5pm 113 m-7pm llam~7pm imam?7pm llam-?ipm mam-7 pm Cuunamm an; uTrx: Ir:? D-Q?nm? nm 1n-am-130nm Counselor 8:30-4pm Clin. Director 7:00-33:11 7:00-5pm 7:00-5pm 7:00-Spm . 9am-5pm Case Manager 9:006 :SOpm 9:00-5:309171 9:00-5:30pm - 9:60-5:30pm I Case Manager 8:00-4:30pm 8:00-4:309m 8:00-4:30pm 8:00-4:30pm 8:00?4:30pm Case Manager 3:00-4:30pm 3:00?4:30pm 8:004:30pm 10~Epm March 26, 2017 _ApriI 1, 2017 Tx-u" :Hg ?Emhlava? 5.. sum wasmam .a?i?fhf??v "5 Friday? =$?i?ffd?w Supervisor B:30~Spm 3:395pm 8:30-5pm 8:30-5pm Cnunselor 8:30-5pm Sza?-Spm 8:30-5pm s:ao~5pm Counselor 8:30-Spm '8:30~Spm 8:30?5pm 8:3U-Spm Counselor 8:30-5pm 3:30?5:13) . 8:30?5pm Counselor 8:30-53 pm 8:30?5pm 8:30-5pm 8:30-5pm 8:30-Spm Counselor 113nm pm llamem 11amw7pm 11a m-Ypm llam7pm ?unsemr lu~am?pm :1.auam~2p1u luau nanny: Counselor 8:304pm 51in. Director - 7:00~5pm 7:00?5pni 7:00-5pm 7:00:5pm Case Manager 9:00-5:30pm 9:00-5:3013111 9:00?5:30pm - 9:00-5:30pm Qam-?Epm Case Manager 3:00-4:30pm 8:06?4:30 pm 2:00-4:30pm 8:00?4:30pm 8:00-4:30pm Case Manager 8:00-4:30pm 8:00-4:30pm 8:00-4:309m 8:00-4:30pm 8:00-4:30pm 10-5:00 pm? 10-513 2017 CALENDAR YEAR Mon day Tu asday MARCH CNS CQUNSELO RS Wednesday Thursday . MD FIRST cw gr- wsex Fri-day Saturday Sunday r-t at} {'31 01 I 84:30pm 9-5:3IIpm . 2~8z309m angquOpm :30pm 4:30pm mevm?npm 02 03 I: 945:3]: pm 29171-10:um mam-5pm 04 -113m-7:3E1pm 05 06' 4:30p 5-550pm 45mm 36:30pm or 9-5309m 09 5:30pm 1 11? 12. 12-8:30pm ?rm-10:30pm, 12~azanpm {am-10309111 ram-19:30pm -8:3.Uprn -2p m~1030pm mam? - 13 8-5pm lib-8:30pm Zm?lo?opm 8-5pm 12-B:Bnpm 2pm1080pm way- 14 8-5pm 12-8: 31me -2pm?1D:30pm 5pm R'w?pm 2pm-?105Upm 15' i7 3-5pm Danvers) 10~Gpm_ - 2pn1410.30pm Elam-Gym 13' 112m?:30pm . 3.9 20 :30pm 9-5:30pm 2pm-10:30pm 2pm-10:30pm 21 23 - :30pm 96:3me 2pm-1D:Bopm *jil? ?Dam-6pm ?2?5 iam??:30pm 25 95:30pm 12-8:3EIpm pm-10:30prn 34:30pm 9:45 30pm 2pm10a-u RCA - WESTMINSTER - OPERATIONS MARCH 2017 SCHEIJULE: INTAKECDUNSELORS SHIFT DAY Summ' MONDAY TUESDAY WEDN smunym ossa-uaom. . 4 . . 1531142330 hr. - WESTMINSTER . Ramver su or?E eciallst Master Scheduse: Updatgd: 3 Mar 2017 13m} hr. mi. Ell-5193 . QM TUESDA 1: Am A132 3130- (351 160:! hr. 'cssz I'll- A135 1 2nd Shift A132 153:: - :35 1 moo .?ssz mshift km 1331! . ATS 2 0350 HR. C55 1 RCA - WESTMINSTER OPERATIONS 1 . MASTER SCHEDULE: CASE DRIVING SHIFT DAY MONDAY TUESDAY WEDNESDAY THURSDAY . FRIDAY I SATURDAY 'ason 1533 HR. 1230 - 2109 HR. DCD information Lice nse No: 093? Program Name: New England Center for. Addiction Medicine Program Address: 2781 Renaissance King of Prussia-PA tacos oco'rssue Date: May 17, arm? . - I . Due Date: in no 01, 3117 . - BSAS - Regulation Areas or Non?cmpliant?e? instructing-?5' - gliorrectillefnction Plan? Attachin?nis {if 7 154. 043 Based on Interviews and a review of the staff schedules provided bythe program it was Identi?ed that the progr a sta?ed with the appropriate number of recovery specie lists as required by the BSAS staf?ng guidelines During the tour of the facilities and in reviewing video footage it was observed that many clients were walking freely through the building without staff oversight. During a review of the video footage it was observed-that staff were not providing oversight in the dining room during lunch the day the incident occurred. it was Stated uring intendews that specialists are responsible for providing oversight In the dining room and ensuring clients gettc and from their units. Based on the information collected as part of the investigation, til are was no indication that program is providing trauma informed care. During video review, it was observed that several clients were touching other cilenis during lunch with no intervention by staff. For exampie, hugging and other excessive contact. 1. Submits plan andtimeline 1.- "g 2? training information. . demonstrating how the program will RSS Staf?ng grid has been analyzed for com pliance with BSAS staf?ng ratios forATS arm-Iraq unto: Rat-In oft-1H staff on 1. RES Staf?ng Grid] RES Staf?ng Schedule {Exhibit 1} Submit a revised RSS schedule for each of the programs - Submit a quality assurance plan to 2. ensure the health and safety of clients and staff. The plan needsto include retraining of all staff on Trauma 3. informed Care. Provide the name of the trainer, date, duration of training and sign in sheet. Training needs to include and practice coon rtunitles and how staff?s knowledge will be measured on the S. ATS 11(2) star-foo CSS fora total of 5 staff fo orients is consistent across all shifts. BEAT exceeds BSAS staf?ng requirements by .5 staff per shin distributing 5 employees per shift across three shifts daily for T2 patients. Staff recruiting is rolling and ongoing to. ensure a rich pool of both regular and per diem sta?. Staff recruitment plan includes, but is not limited to, the following activities: internal: job boards, employee referral program, and job fairs including an onsite one 6/5/37. A new staffs?day Orientation is being implemented on 7/1/17 with a secondary plan to retroactively train all employees by lning/ retraining will include, but not be limited to: Trauma informed ca re, clinical programing, Human Resources overview, Company objectives, substance use disorders, operational issues, and training on the patient handbook. Postutests will be administered to measure employee knowledge retention. . All current R85 will be required to complete . Trauma informed Care by 5/151? in the Relies Learning System as Well and BEAT will provide evidence of such time. Training Curriculum 3. Orientation {Exhibit 2) b. lie?training (Trauma Informed Cara) (Exhibit 3} 164.035 Based on the review of program incident reports, it was learned that some incidents occurred that should have been reported to the Bureau of Substance Abuse Services, however, no required noti?cation were Submit af?nnation from this point 1. forward all Required Noti?cation will be submitted per the above regulations: 2. Submit all past Required Notification that BSAS should have known about. All Required notifications will he made per 164.035 All past required noti?cations were - submitted on Sin/1?. 1. Af?nnation of submission of Required Noti?cations (Exhibit 4} Copies of past noti?catio n5 dated srws?r. {Exhibit sl on .- v-r' un- . submitted as required In the c?rted regulation. 1.54081 During the investigation, C15 revieWed the - 1. Client Manual. The policy and procedures - in the client manual do not coincide with what interviews explained as policy. For example: the smoking policy Re?aw the current client ma nual and update all policy and procedures that era not current. Submit a time line when the updated manual will be com pletad. Submit an updated client manual upon oomp_letion The patient handbookwas reviewed and revised to ensdre all polls}! and procedures ore-accurate andcurrent. Please see attached reissued handbooks. Revised Patient Handbooks a. ATS 13. C58 6) 154.038 During interviews with staff, no staff 7 1. person was able to identify the Program DIrector for the ATS or CSS unit. Submit an organizational chart that identi?es the program director forms and CSS unit; please include job mm as an resumes forldantl?ed Organizational chartsfor both ATS and C55 unlts distinguish leadership and chain of comma nd to 1- program oversight Director of Operations will notify in writing Organizational charts 2. ATS h. C53 {Exhibit program directors. Submit a plan on how staff will be boomed or: who provides oversight of the programs. all start or program up Tu: Ki": 1:55 un?s - Framed coples of the organization charts will be located at all nursing stations In both the ATS and C55 programs. ri mm; nF {Exhibit 3) Photo of framed organizatlonel cha rt {Exhibit 9} I 154-040 'During the interview, it was stated that 1. Recovery Specialist are responsible for taking the dining room durlng lunch and dinnertime as well as taking clients outforsmoke breaks and prodding oversight during lunch and other times. A review of video footage identi?ed that staff are not following program policy and procedures. Suhr'n?rt a plan to retrain recovery specialist on theirjob ?mctlons as well as retraining on all policies and procedu res and protocols. Documents to be submitted: name oftralner, date, duration of training and sign in sheet. Submit job description for Recovery Specialists. a. All new hire R55 will be trained aocording to the revised training plan effective within three days of hire. All exloting R53 staff will be retrained according to the revised training plan by Willi Th it RSS supervisor will provide 2~3 trainings weekly until all staff are retrain ed. Evidence of th is be located In the employee personneif?es. curriculum (Exhibit 10) RSS Job Description (Exhibit 11} Name of Trainer, date, duration of training and sign in sheet Will be submitted by 7/10/17 Recovery Support Positions Weekly Schedule FT) Sun~Thu Ff) Sun~Thu FT) Tue-Sat FT) Tu e?Sat Fr) Fri~Mon FT) F?-Mon FT) Slim-Wed (PT) Th u-Sat (Ff) Sun?Th)! (Ff) Sun-Thu (FT) Tue?Sat (FT) Tue-Sat Fri?Mm Fri~Mon (FT) Sun?Wed (PT) ThuJSat (FT) Sun?Thu (Ff) Sun?Thu {Ff} Tue?Sat (FT) Tue?Sat (FT) Fiji?Mon (FT) Fri?Mon (FT) Sun~Wed nun??- .- Exhi CR . - 9:0Ga m?S??am 9:303m- ibiSQam 16:30am; 12:30pm . 12:30pm- 1:00pm 1:00pm?1 :3me 1:30-20ng 2:00pm 1155:00pm 9:00am? ai?am 12pm- 12:30pm 12:30pm? 5:00pm I . 10:45- 11:00am ?12:30pm 1230-13810?: 1:D0pm~ 5:00:15 ?mom?12:30PM New Hire Orientaiien Program Dav 1 (Monda? I: ADPIngliasl Share Point registration Presentatian continued! Review Org chart Lunch Badges Supervisor/Deparlment introduction Job Shadow I r? D31 2 (Tuesday) I Operations? ?re safety/keys/Iocked doqr? Lunph I Reiias (Wednesday; - Clinical Core I Break Patient Content Overview Lunch Job Shadow Day 4 (Thursday) DenEscalatior?I w?a . Documema?on WEB ASAM 101 WEB 12:30pm-I1:00pm 1:00pm? 5:00pm 8:30am 12:30pm 12:30pm 1:00pm 5:00pm Lunch Job Shadow - Dav 5 '(Fridair) Relia's Traim?g Lunch . Clinical training? Boundaries, Confidentiality; Patient HB 51311201 Relies Recovery Centers of Marlee Introduction to Trauma-ilnformed Cate 1.5 hours 4.3 (93' _g - meme . 352270714 Content. Expita?on 9/30/2013 Type . SOS-Compliant . BrairiSpai-ks (Enabled) Description (Objective/Burma) . Dyer 90% of people receiving behavioral heatthcare have a history of trauma. In this course} you will learn about the various types of lrau ma, the long?lasting consequences of oeumer and what it means to provide care through 'a trauma- informed lens. Through interac?ve practice scenarios and detailed examples, you will learn the scope of your role and tesponsibilities when you are serving individuals with histories of trauma. You will examine bat practices to implement, as well as how to avoid hammi ones that can further perpetuate?the suffering and silence'of iraume. As - you complete this Course, you will gain a deeper understanding of how your personal history can impact your work with trauma survivors. Importantiy, you will learn'what it means to provide trauma-infomed care, and why this approach is a multi~faceted one that you should consider for the individuals you serve. This training is designed for behavioral healthcere professionals who interact with individuals iri? a va?ety pf 4 ?a . . nan?n.? - Print Exlm'law 3 1110 . . Relias- Racovary Centers ofAmerica behavioral healthcare settings, inniucimg those with basic to intennediate levels of - experience with trauma. and are registemd trademarks ofthe American Association. The American Associa?on is not with nor endorses this course. Coursg Gatline Section 1: Inhnduction A Churn-.8 Cnnh?ihutqr - . B. Abaut This Ceurse - C. Learning Objec?ves Section 2: Wei-view ofTrauma and Its Irn pact . A. Meet Janine B. More about Janine 1.- C. Jamil-12?s Intake - Prevention E. Abuse in America E. Types of Trauma G. De?ning Trauma H. Useful Tenns about Trauma - I. Is the Current System Making Progress? - J. Why Does Trauma Matter in Behavim-al Healthcare Settings? . K. Canneiia?s Daughter . L. Summary Section 3: When Trauma Pervades A. studies that Shed Light on the, Pewasiveness of Trauma 8. What?s Your ACE Score? C. Univezsal Precau?ons' D. Jordan?s Judgment E. Review F. Varied Trauma Reactions G. Central Theme of Trauma Reactions H. Meet Ronnie I. Ranni??s Return J. Parsing Out b15uslalom? . Reliao? Recovery Centers ofmrica x. I . K. Summary Section 4: Resilience-and Growth . A. Resillonce and Trauma in Posttrouma?c ?3th . . C. Tonier Cain: Ar: Example of Resilience D. Tonier: The Change E. Meet Lila and Rosa F. Their Story 6. Review - Summary Section 5: cultural vs. Cultural Competence: Setting War Traumadnfonned Care A. ACultural Huml llty 8. Cultural Competence C. Fear,'Shame, and Guilt D. Trauma and Culture: Meet Mr. Loo E. Mr. Loo?s Cultural Considerations Mr. Loo: What G. Using the: to Incorporate Cultural Conslderations H. Review I Summary QC. Section The Trauma-Informed Care Approach - A. De?ning the Framework of Trauma?Informed Care B. Distinct Charact?rlstics of a Trauma?Informed Care Approach C. Why-Should You ChOoseth?Is Model? I). When Should You Choose this Model? E. Quick Check F. The Importance of Self-Care G. Ways to Practice Self?Care H. Tlago?s Trauma Center I. What Should Tlago Do? 3. Summary Section 7: Tools and Techniques for Implementing Trauma-I nfonned Care: . A. Screening B. What Should You Look For? a C. Assessment 4_ . I 3?1 . . Relies Recovery Centers ofAme?oa . 13. Quick Check . E. Implementing Change F. Trauma?Speci?c Interventions G. How to Promote Resilience H. Barriers to Treatment I. Meet Jase . 3. Summary Sector: 3: Conclusion .- A. Summary - 8.. Congratulations! Learning Objectives De?ne at ieast three types of trauma and the pervasive impact that Home has. List four essential components of trauma-informed care. Provide at least two exampies of how and when you should implement oaumaonfonned care in your own work Setting. AdditioriaiInform?ation Instructor mend Sharp, MSW, IMWT, . Cheryl Sharp, MSW, ALWF holds a Bachelor ofArts in and Women?s Studies from East Carolina University and a Master's Degree in Social Work with a focus on Health and Aging, She holds a unique perspecljve as a trauma survivor, an execonsumer of behavioral health services, and as a provider of these services. Her experience working with adults who have'exoerienced trauma, grief and loss spans three decades..-Cheryl is currently the Special Adviser for Trauma-Informed Services for the Na?onal Council for Community Behayioral Healthcare. She provides technical assistance and oonsuiting services to National Center for Trauma- Informed Care and Promotion of Alternatives to Seclusion 8L Resoaiht . - through Trauma-Infomed Practices. She is also the pmjeot coordinator for the . . 4? 513mm? Naju Madra, MA National Council?s Adoption of Trauma-Infomed Practices Learning Communities? Disclosure: Cheryl Sharp, MSW, IMWT, has declared that no conflict of interest, Relevant Financial Relationship or Relevant Non~Financial Relationship?e?sts. Staff Writer Naju Moore, MA. is an internal subject matter expert and clinical content writer at Relies Learning for the Health and Human Sewices library. She has her Meier?s degree in with Speci?c study ln Clinical Neuropsydiology; She brings with her a wealth of experience in clinical assessment, training, curriculum development, and research project management. She has over l5 years of behavioral health Relies Recovery centers of America Financial Relationship or Relevant Non?Financial Relationship exists. . The target audiencefor this course is: entry and lntennediate level Nurses; entry and . Relies. Learning has a grievance policy in place to facilitate reports of dissatisfaction. Learning Customer Support by calling (800) 381-2321 or emailing expenence, lnCiLiUiTlg scholarly amvm6? 1:qu :15 writing manuals anti yr sparing manuscripts for peer-reviewed journals? . Disclosure: Najo Mad ra, has declared that no conflict of interest, Relevant Target Andience intermediate level Social Workers; eno'y level Alcohol ano?Drug Counselors; entry level Marriage and Family Therapists; entry level Professional Counselors; in the following settings: Health and Human Services; and the following practice categories: Addictions, Corrections, General Nursing, Gerontology, Home Health, Mental Health, Pain. - Relies Looming will make everyeffori: to resolve each grievance in a mutually satisfactory manner. In order to report a complaint or grievance please contact Relies Looming at support@reliasleamlng.com. - If you require special accommodations to complete this module, please contact Relies nor-u support@reliasleaming corn. All courses offered by Relies Learning, LLC are developed from a foundation of i diversity, inclusiveness, and a moi?coltural Knowledge, values and awareness related to cultural competency are infused throughout the course content. To earn continuing education credit for this course you most achieve a passing score of 80% on the post~test and complete the course evaluation. . N8 Recewcd by; mums/16 BSAS Complaint Intake Form Reporter Nam . Reporter Contact i donation! Reporter Type liont [:[Ctlent Friend or Family Member CI Program Staff Person [3 EOHHS Agency Other forrnerstaifmemher Time of Catt: 9:20am - Gal_ler was advised of 42 CFR Part 2 and need for signed releases Yes Licensee rvioe Name Recovery Centers of Amerloa at Westminster (0399) Addressmca?onq Village inn Road Westminster. MA 01473 Date of incident Relevant Documeni is Attaohed alter is former employee of the detox unit of the program Nature Of Reporth hey were concerned about patient care and resigned. Celier WHO eis they are not providing the proper care and are understaffed . hey stated there :3 currently only two therapists for the whole of more than 30+ clients. WBAT . Lr'here IS atso no programing for the detox unit They are grouped i with the CSS programming and groups Caller stated they were rtder the impression that each Unit must have their :3an WHEN . programming and that grouping them together was not don?dential or individueiized like it shoutd be alter stated they have several people still employed at the WHERE rogram that can vouch for this complaints Validity. . I eller stated that this has been going on for as tong as they were WHY . orking at. the program but not elaborate on how tong they - ere employed. Caller-gotta Consent to use their name. Assessment and ioritization UCIient advised to oomptete programs grievance process - UCaiier was referred to another jurisdiction that has authority of this matter EJCeiter advised to submit a written complaint Cttnoident deemed valid oompiaint (reguietmy. or contractual vioietion) {Homer EVerbai Consent ven - Estated No Follow Jp Provided to Caller - Revised: 10f2016 R. A lad leco?rery Centers 0f Amarica. Training Plan andlfiral Hepatitis is provided during the onrhoerding process for all staff on . Relies Online Training Courses (see attached outline]. An additional level of timing will be given to our Nurse Case M'enager who is RCA Westminster's designated Cc ordinetor. implementation will inqlude one group per wee-kin both the CSS and ATS unit. Documentation will he done on each patierlt in individual progress notes. Overdose Prevention be done weekly by our Clinical Coordinator'in both the ATS and C55 unit, to include Noreen Trei ng. Additidnal training will be done with individual patients as needed and - documented in the EM 1 Individuei Progress Notes. We are working with o1 her companies that provide and Viral Hepatitis training including mos Project Worcester and The Center for?Soclal innoyeicion to provide an additionai level . of training to both staii and patients. 170 Renaissance Blvd, Fioor, King of Prussia, PA 19405 i - This course provida basic alien on HIV and AIDS. We will de?ne HIV and AIDS. how the immune system works and doesn?t work with HIV will also discuss testing for the HIV virus and weahneni; for the infection. Disclosures: Nancy Logo APRN. - and AIDS. We discuss how HIV can and cannot be transmitied..The course has no relevant financial or nonfi oaoclal "relationships to disclose. course Outline Section 1: Introduction . . A. About'i'his Course . E. Learning Objectives . (3. OSHA Requirement Section 2: overview A. Meet Mary B. What is What is AI C. HIV Progression . D. AIDS Progression - i -E. Mary; What Went Wrong . F. Review G. Summary Section 3: l-hmr is HIV hansrhitted? A. Fluids of Transmission . B. Traosmisslon of HIV C. How HIV Is NOT Trans irked D. Standard Precautions E. Additional Preoau?ons F. Post?exposure Prophylaxi H. Prevention Strategies: Protection during Sex 1. Prevention Strategies: Using a Male Condom 3. Prevention Strat?gles: mg a Female Condom K. ?eventlon Strategies: B?rriers during Oral Sex 0 9 . G. Prevention Ovewiew . . L. Prerentioo Strategies: Fifh??aw . N. Summary Section 4: HIV Patterns A. HIV Across the globe C. HIV Patterns D. Age F. Multiple partners G. Intravenous Drug Users H. Race and Ethnicity . I. Perception Knowledge Is Power M. Review N. Summary 27011 oice of Sea-tool Partners 8. How Common Are HIV are AIDS in the United States?r E. Gender and Sexual Behaviors K. How Many People Are Infected and Do Not Know It? L. What Should You D'o If Exposed to the Virus? Renaissance Blvd, Fine r, King of Prussia, PA 19486 .. .. . Section 5: Testing A. Who Should lGetTested? B. Types of Tes?te - C. Con?rming and Diagnoelr Tests Interpreting Resuits E. Where Can Someone Get an HIV Test?- F. Home Tests - G. Con?dentiality_ H. Repor?ng Requirements I. Con?dentiality J. Post-Test Counseling K. Revlew L. Summary - O?lnla?t?int? Section With HIVIAIDS A. Treatment: 8. Stigma and Prejudlce C. Re?ew 1). Meet Jeff E. Living mm and Managing F. Starting Out Hearthy . G. Stemming Weight Loss: Bring on the Calories! H. Stay Hydrated I. Keep Food Invaders Out 3. What about Sec? K. More about Sex L. and Finances M. Review N. Summary Section 7: Condnsion a A. Course Summary B. Resources - (3. References Learning Objectives . . - Define HIV. De?ne AIDS. the role of the immune system. Describe ways that HIV can be transmitted. Identify two recommendations HIV testing. Explain the difference between a screening test and con?rmatory lest for HIV. Describe the imgac't of an??retrovlral therapy on the disease course. . - Additional Information -. . . - . . - - Instructor Nancy Luge, APRN . Dr. Luge, a family nurse practitioner and public health expert, has provided care to thousands of Individuals and families. She has-deveioped community based HIV testing programs, community heaith worker programs, and programs for people wilh AIDS. She has shared her amortize through university teaching, workplace?heal?w coaching, and on memes, peer-r aviewed pubiicatlons. Disclosure: Nancy Luge, has declared that no conflict of interest, Relevant Financial Rela?onahip or Relevant Non-Financial Rela?or ship exists. arget Audience . 111a lerget audience for this coTrse is: advanced level General Staff; entry level Alcohol and Drug Counselors, 27C 1 Renaissance Blvd., Floor, King of Prussia-PA 19405 esslonal Counselors; entry level Social Workers; entry level Speech and Language Pathologists; in the fell ing settings: All Healthcare Settings. . Relies Learning has a grievance Hay in place to facilitate reports of dissatisfaction. Relies Learning will make every effort to resolve each griev one in a mutually satisfactory manner In order to report a complaint or. grievance please Contact Relies rning at support@reliaslearning com. - If you require special accommod one to oompleto this module;;p18ase contact Relies Learning Customer - Support by calling (800) 381~232 or emailing support?rellasleamiog. oomf I All courses offered by Relies Lea lng, LLC are developed from a foundation of diversity, inclusiveness, and a multicultural perspective. Knowle e, values and awareness related ho cultural oompebency are infused throughout the course oonfent To earn continuing education creiit for this course you must achieve a passing some of 80% on the post?test and oomplete meoouree evaluation - entry level Nurses; entry level 2701 Renaissance Blvd? 4? Floor; King of Prussia, PA 19406 . Bloodborne Pathcb?ens ?15m M43 {1499) mm it 334004561- uanmwaqaim mam-1121 Tm Audio - magma: . mummtawm Dmip?m (W) anf?umrd hjmv?wvmiq?zaa?hkm mm r?lb?tyufeadzwd?myanmym mm mm? in swarm fummi i1 Miriam-lg Im?h?m . . - AirhpaH?s? - a - . gamma}: a I EWFmiediveEqummt . El?n-rd (hammia?m - 53?in kam a 1. mum-sum oridTreahrisni: II E. Dumnmt ?cl/W QEWW Maximum nm?mmalv - *3.me - QW cam . Emml? Gain abettegum?mcing ofmt mi?qunm BBP. Km?nede?i??m of Bamtypegam [191:me Imam; andbeabk-mmknappmm acumvdam mama. - . Hr,mABambammheat?y -. min-pursuit, hush-Ea mnanmanag peninsula? whiz: hemb WLa?wmreprepamm . . mmnamm tie-lemma leading mm ma?a. mm??mmrma?: W'mf?mmwuu; Federan?ebu?sa?aswsofpubfk: a. - mmunmtme?muc?wm, - - - -: EWWMIWWM .. Wire when - - Warn?: Rama . Ori?wmbamt?um?wmw I petting. Mme: N?nny Bantam, mm, my 34,. mar, emu. mm, PPM has dadnwd mains ?911de Memntl?hn leh?pm?R?mMM?-?md? . warm 1m 1hr mama manta unfulkmm mummn Rains Isamhg hast: aria-mm mm habitats: muadmw?c?m. Reba; - mummamuw?ysa?maawmm Inu?crmrepmtaminpmargrhanm Irwu mqulm spudd plate 11:1: mettle, Hem mutactke?as Lemma Sal-mimap?m wmmum WmmIMmingedumm Heifer mum 5w mam a mamdmaa on Ina Warn! m??nm Mm. El Recess Castes demerits Title: Performance improve-m ent Plan Policy No: 8000 Effective Date: June 2021.6 . Review/Revision note: Page 1 of 7 Manuel: Performance improve nent Related Departmentis): All FIHIPOSE: The purpose ofthe Performance Governing Bo dy, medical staff- a that is optimal in an environment Plan allows for a systematic, coo processes and mechanisms that a mprovement Plan at Recovery Centers ofAmerice (RCA) to to ensure that the [d piofessionel service Ste?' demonstrate a consistent endeavor to deliver care of minimal risk In keeping with RCA mission the Perfonnane'e Improvement rdinated and continuous approach to improving performance focusing up on the :ldress these values- The following sections de?ne the protocol for this Continuous Quality Improvement Plan 11. costs on PERFORMANCE MROVEMENT: The primary goal ofthe Pcrfo co Plan is to continually and systematically plan; design, measure,- assess and improve pe of facility~wide key ?mctions and processes relative to patient care; To achieve the primary goal, the p12 strives to: A. Incorporate quality plate 3ng throughout the facility; B. Provide a systematic mechanism for the facility?s appropriate individuals depertmonts and professions to inaction collaboratively 1e their efforts toward performance improvement; C. Focus upon what is per care. To facilitate this performance include: nned throughout the facility, and how well it is performed to provide health s1, emphasis is placed upon "dirnonsions of performance". These dimensions of . rocedure or treatment in relation to the patient's condition; of a speci?c test, procedure or service to meet the patients needs; needed test, procedure, treatment or service to the patient who needs it, which a needed test, procedure, ??ca?nent or service is provided to Effectiveness 'th which tests, procedures, decedent and services are provided; . Contieuity of services provided to the patient with respect to other services, practitioners, providers and or time; Safety of the em: (and others) to whom the services are provided; Ef?ciency wit which services are provided; Respect and 0 log with which services are provided. E?icacy? of the D. Provide for afaoility-wide program that assures the facility designs processes (with Special eniphasis on . design of new or revisions in established services) well and measures, assesses and improves its performan cc to achieve optimal patient health outcomes in a collaborative, cross deparmlental, ioterdisc plinary approach. These processes include mechanisms to assess the needs and . . expectations ofthe pen? cuts and their families, staff and others. Process design contains the following focus elements: I Comistency ththe organization? mission, vision, values, goals and objectives, and plans; a - Meets the need 3 of individuals served, staff and others; Use of clinical?r sound and current {late sources (for instance, use ofpractloe guidelines, information ?re in roleVsnt literstore and clinical ME . Elli . Reactor Cantos slamm- . Title:- Performance Improvement Plan Effective Date: June 2018 Manual: Performance Improvement Related Department(e): All Policy No: 3000 Review/Revision Date: %m2w7 Is based?upon sound business practices; Incorporates endgame commotion from intemal sources and other organizations about the occurrence of me institution; Assure that the improven quality and appropriatcne identi?ed problems ead'tl 1 Body to provide the lcedt. patient care and safety is ice! errors and sentinel eVents to reduce the risk of similar events to this out process ie organization-wide, monitoring, assessing and evaluating the es of patient care, patient safety practices and clinical perfonnanee to resolve nprove performance Appropriate reporting of information to the Governing re with the information needed to ful?ll its responsibility for the quality of a required mandate oftbis plan. Assure that necessary rotation 13 comanioated among when problems or opportunities to' Improve a?ent care iet'olve more than one dopettznentfeervice; and that infomation from detect trenda, patterns of Identify important key as frequently or affect large deprivation of subatomic end the ?ndings of performance improvement activities are used to performance or potemial problems that a?cct mono than one department/service poets of care for the health and safety ofpatients. Included are those that occur numbers of patients; piece patients at risk of serious consecuenoee of bene?t ifcare is not provided correctly or not provided When-indicated; or care provided is not indicated, or those tending to produce problems for patients, their families or staff. IEADERSHEP: The role of leadership IS of paramotmt importance in the performance improvement process. This responsibility is accompl 4: Adopting a Setting Priori?o Waging, Establishing an Events Assessing the Approach: The leaders perfonnance measutetc lobed to a number of Ways following several key procesees: nuance ImPIOVemeot Approach and Allocating tee emcee for assessment and improvement activities ng and Participating PI activities 1 Leading aProeess for Review of Signi?cant and Untowerd events and Sentinel ectiveness of the PI progzam including Leadersbips? role Assuring that provements are sustained overtime tabh'eh a planned, systematic, organize?onuwide approach to promos design and 1; analysis, and improvement. Performance improvement activities are most effective when they are lanned, systematic, and orgax?zaticn-wlde and all appropriate individuals and professions work collab rativeiy to plan and implement them. Quality Service Management: I a Every ompl: Quality cert A11 individu faciliw-widt Cuato'mer 5: Everyone in service ement: The leadership at RCA hes embraced the principles of Quality Service wee actioe impacts customer satisfaction ice must be stated in speci?c behavioral terms to ensme its delivery 31 Service-related concern within one area of?ze facility must be rede?ned as a 003103111 ttisfaotion and employee satisfaction are inseparable the facility must be held accountable for constant quality customer El. Ramsey (Icemm?moica Title: Performance lmprovemlent Plan . . PolloyNo: Effectlve Date: June 2016 . . Revlewj?evislon Date: Menuai: Performance lmprovawant . . Page 3 of 7 Related Dopartmen?e}: All 0 The facilityraust receive objective feedback from its exter?al and internal customers . 0 Success is detexmioed by the satisfaction levels of customers I PDCA: The leadersllip ati'RCA has selected the PDCA approach to?perfonnaooe improvemeot. {19" Plan the pro! itpprovomeni vement, data collection 85 analysis nits and lessons learned 0? Setting Priorities: RCA see a dynamic and moltiiayered approach to setting priorities forperibrorance improvement, moludmg . . 1. Eviden- aod ?ndings from the national and local health care community; 2. Emer best and evidence-based practices; . . 3. Data frm. ire om experience error ?le lastyear and major issues and problems accounted; - 4. Disc on, pe?spective and insight from leadership and?froat line support and oliziical staff: . 5. Results 1 cm the annual summaries of key areas of perfomleuoc such as quality monitor's, infec 2 control, human resources; and, . 6. - Baler I meadows from local, state and fedora! governments and law I). Allocating Resomoea: disciplines, and do . E. leading, {managing an- .e organization uses appropriate resources and involves those individuals, I - ents- closest to the process, function, or service identi?ed for?irnprojremeot. Participating in P1 Activities: The leaders sot expectations, develop plans, and manage processes to as ass, improve, and maintain the quality of the organization's governance, management, clinical, . ad support activities. These may include aetiqi?ee scabies: 'eal sta?s authorities and responsibilities are stated in writing and include receiv?: 5, and acting on reports and recommendations ?cm clinical staff coenoitt'ees, progr and services, When applicable. - Profes ional and administrative sta??s monitor and evaluate clinical perfonnanoe and the quali of care provided to individuals served, resolve identi?ed problems, and report info 'on to the governing body to help it ful?ll its responsibility for the qualityr of care for in viduals served, 7 . - . - dare ensure that processes and activities most inrpormot to clinicai outcomes are contio ously and systematically measured, assessed, aed improved throughout the org I tioo. 1 Lead- and directors must engage all staff with managerial responsibilities in the process . naanoe improvement; This requires establishing clear communicatioa processes and . igoiog accountability for followthrough; Leaders Set the tone for participation in- interd oiplinary performance improvement activities by participating in such activities Ell . El. dormers ?title: Performance lmprovem ant Plan Policy No: 8900 Effective Date: June 2016 Revlew/Revrslon Date: Manuel: Performance improvement Page 4 of 7 Related Deportmentts):ml - - A?sacoe coordinated performance improvement process depends on communicating operating procedure. collected as part of perf IV. - inlprovement over time - their contribution to per! its cocci sions arid recommendations to individuals reopensible for carrying out and. perform AsSessiog Effectiveness: established, objective 1) improvements Accountability' to established for speci?c improvements to their implementation. To do this, leaders also need relevant infomm?on ??orn oe improvement activities 5 and procedure improvements to be done successfully, accountabilities must The leaders set measurable objectives for. their work to improve organimtiori' eess criteria to analyze and assess their attractiveness; draw conclusions about performance; ga?rer infiimation to assess their e?ectiveness in improving perfonoaoce; use pre- and evaluate the e??eotiv ?nance improvement; develop and implement improvements in their activities; eness of torproveroents to their activities Assuring Improvements Are Sustained Over Tiroe: E??ective changes are incorporated into standard 1e organization sustains improVement through education of key staff about the new prooess(es), or redesigned prooeSS(es) or other changes being implemented. Baseline data is collected and per'fo measures are used to determine iftbe improvement is sustained. Data are The organization also events known to occur rnianoc monitoring. Feedback is provided to staff and leaders on a regular basis. sees the risk of sentinel events by using available information about sentinel tb signi?cant frequency in health care organizations that provide similar care and services This Is do so that the organization can. design or redesign care and services to prevent tlie event ?'Orn occurring to The scope of the Perfo to organization once improvement Plan includes an overall assessment of the ef?cacy of performance Improvem nt activities with a focus on continually improving care provided throughout RCA. collaborative an Speci?c indicators of both key processes and outcomes of core are designed, measured and assessed all appropriate departments/services and disciplines of the facility 111 an effort to impmve organizatio perfonnanoe These indicators are objective, measurable, based on current knowledge and experie co and are structured to produce statistically valid performance measures ofeare provided This tees 5111 also provides for evaluation of unproVements and the stability of the - A Interdisciplinary Committees: 1. Special Review Teams: Interdisciplinary Teams may be created by the Performance . Improvement ornroittee to focus on particular problems or processes, plan for change; measure the e?eet of ch mge, assess the result and improve performance of facilitynwide key ?roc?ons and . processes. These teams will be developed on an ad hoc basis and?will report to the Perfoonaoce Improvement interdisciplinary mmittco and, through the PI Committee, to the Governing Board. Teams will be in nature, comprised of department supervisors, medical sta? as needed and "Hue: Performance [memo nt'Ptan . - Policy No: soon. Effective DatetJone 2016 Review/ Revision Date: Manual: Porto rm once improve went Page 5 of 7 Related Departmen?e): All I those individuals designated from each department, as appropriate, who Irony have the highest . degree of knowll :dgo regarding a given topic. - . . onitoring: Each clinical department or Service in the facility will develop a plan for ongoing mox?toring and performance improvement, relative ?to the types of services . provided Such lens will include standards for performance and evaluation procedures designed to satisfy the ob etives stated in this Folioy. Reports of all clinical services will be madeto the Performance rovement Committee on a quaterty basis. The dimensions of performance of patient care an nality assessment and improvement activities in the following services are monitored, asse sod and evaluated: . Naming Senrioes a Clinical Services 0 Medical Services 0 Phannaceutioal Services for pe rmanoe improvement. Reports on all patient/sta? satisfaction activities will be ?d to the Performance Improvement Committee on at least an annual basis. 3 a 3 . Facility?Wide atisfeotion Surveys: The Governing Body has established mechanisms to assess the needs and peotationo of patients and their families, staff and others. The fo?ovdeg Facility? Wido Surveys conducted "and reported to the Performance Improvement Committee, which analyzes the do and identi?es Opporomities to hnprove sersioe performance and presents this date to the Gov owing Board: . I Patient Survey; - Referral Source Survey; . a Employee Survey 4. In hanging on the Performance Improvement Pian, the Performance Improvement Comn?ttee . will seek to 35%: that assessment of the performance of the foliot?ng patient cane and organizational c?ons are included: . Patient Rights? and Organizational Ethics Assessment ofPetients Education of Patients and Family Care of Patients . Continuum of Care leadership Infectiml Control Utilization Management Safetyi?isk Management Human Resources Care oftho Environment Management of Information 5. Quality Monitors: In canyiog out the work of the Special Review Teams, Departnlent . Monitoring a; Facilitynwide Monitors, both internal and external quality menitors shall be used [Ell El Renew Cameo dinning T?lei Peiformanoe lmprovervent Plan Follcy No: 8000 E?eotive Date: June 2016 Review/Revision Date: Manual: Perfomanoe Improv ment . Page 6 of 7- Related Departmen?s): All to assist in oval ting the quality, appropriateness and effectiveness of the care provided. All . committee, drop on: and facility-wideparformanoe improvement activities shall be based upon of such intomnl external quality monitors, and these internal and external quality monitors shall . a be included in 11 annual plan. -Whon issues are raised by the quality monitors, these shall be . addressed in ill annual plan. . - I. Int-1mm Quality Monitors: types of internai quality monitors include: - Chart Audits Medication error surveys Patient fall on ways Patient injl} Iy/inoidentrates AMA roles Faoility Acquiied Infection Rates 2. Ex nmal Monitora: types of extomal quality monitors include: Feedback ?om Referral Sources on patient continuing care plans 9 Patient Satisfaction Survey National Norms Roports provided by Payers SuNeys provided by regulatory bodies and accrediting agencies 00". Di volopment of an Annual Quality Plan: Each year, aPerfomanoe [Inprovomont p1: or: shall be developed which monitors the quality, appropxiatoness and oifeotiveness of the care provided and which addresses issues raised by the quality monitors. Each In erdis'oiplinary Committee and Deparnnent will submit an annual PI Plan to, the ormanco Improvement Committee for its review; These individual plans will be mitted to the Goveming Body for its xeviow and approval. In addition, the Verning Body will develop Facility?Wide Performance Standards each year. The i ~Wide Standarda?, plus the individual plans of the interdisciplinaiy and Depai'nnents shall constitute Perfonnanoo Improvement Finn that year. . v. ORGANIZATION: PROTOCOL non THE QUALITY comma: . A. The Perfommnoe Impiovement Committee has been established by the facility: 1. To oversee the e??eotiVeness of the Faciliiyis Perfonnanco Improvement Plan, including monitor' F, evaluating, and problem-solving aotivi?es; 2. To semis: as the designated coordinating mechanism for all Facility?Wide, Inierdisoiplinaiy, and depan mental pesformanoe improvement activities; and - 3 . To report needed infomnation to the Governing Body to assist them in ?ll?iling their reaponsib iitios for' the quality of patient care. . EEII El Home Genres 4511136423 Title: ?erformance Improvellient Plan - . Policy No: 8000 Effective Date: June2016 Review/Revision Date: Manual: Performance Improvaent . . Page 7 of 7 - Related B. The Perfonnailoe Imp Representation on the emeot Committee is multidisciplinary in its scope and membership, mmittee will include, at a minimum, the CEO, Medical Director, Director of Nursing, Clinical Direc Infection Preventio'oist, and Quality Assurance Manager, HIM Coordinator, Director of Operations, C. The Performance Imp emeot Committee will: nd Risk Manager. Meet at lea quarterly or as needed to review-data received from performance hnprovement activity in regress at the departmental, interdisciplinmy or faei?tywwide levels- Oversee nitoring, evaluation and improvement activities, assuring that important aspects of patient and clinical perfonnence are reviewed, providing assistance where needed. Receive orts on Suchae?vities; Analyze so 311 material in terms ofoverell impact Oil the facility, integrate information, and detect 115511qu, patterns of perfonnance and potential problems that might affect more than one department. - . . Transmit it formation to depar?ne?t supervisors When problems or opportunities to improve care involv more than one dept; tree}: the status of efforts to resolve problems or ?nprove I care. Maintain acumenmtion concerning all performance improvement ?ndings, conclusions, recommendations, actions and results of actions. - Report rel vent ?ndings from all petformanoe improvement activities petfonned throughout - the ioeti on to the Governing Body on a quarterly basis. . Seleotpe nuance measures in compliance with all local, state, and Federal requirements. . Evaluate e??eetiyenese ofthe Improvement Plan at least annually and revise it as ary. 'ELec'ovcry Centers 0f America- AFFIRMATION This serves as that 1 this requirement will be reviewed through the clinical monitoring plan. 54% I Date 2W1 Renaissance Blvd., Floor, King 9f Prussia, PA 19406 reatment plans will be signed byell required particlpants._ Complia?ce with ac MA Recovery Centers Of America ClinicallCa'se? Management Monitoring Plan~Westminster Menitoring processes fox clinical elements have been implemented under the direction of the . Clinical Director. These I: recesses include chart reviews, group assessment, supervision, and regulatory compliance reviews as detailed below. a Group and/or? In vidu?al supervision will be provided to ail Recovery Specialists, Case Managers, and nlcal staff a minimum of biweekly. The Clinical Director will provide supervision to th Recovery Specialist Supervisor and Clinical Supervisor The Director of Case Manageme twill provide Group and/or individual supervision to Case Managers See attached so rvision log and ciinical supervision note a The requiremen for clinical and case management services and documentation will be reviewed with clinical and case management staff In group and individual supervision. See ttached RCA Therapy and Case Management Requirements, Necessary Clinical Docume tation outline. The Clinical Dire or [and Clinical Supervisor, Clinical Coordinator as assigned) will complete rando chart revievvs on a weekly basis. Each week a minimum of 50% of the Its will be re ieIIved, with the results provided to clinicians "and discussed In bi? Weeklv su pervisi See the attached RCA QA audit tool, . a The Clinical Dire or {and Clinical Supervisor, Clinical Coordinator as assigned) will ensure that gto ps are held consistently, according to the evidence?based group curricula that includes: Multimedia lZ?step Multimedia Relapse Prevention Toolkits, Getting Motivated to Change - Toolkit, Unlock Your Thinking TCU Toolkit. See atta shed R55 Facilitator Auditing Protocol and Supervision Checklists for groups. -. Recovsry Centers ?f Ammica Patient Name; Admit Date: Tr.- Mun"; ?rah?; s. -, . 3231?1. .j Bimini .1533? 35:31., 2. a. i .. .. Admission - Discharge Evaluation complet: Treahnent plan compieted ?I?reatnent plan update. (from admit r. am) . a ?glow Dimension 1:Briafcomment ing acute ?itoxica?on ?ndfor withdraw potent a] progress or Status Dimension 2: B?efconmem at! conditions and comp?cations sing biomedical 55 or status behavioral, or cogl??vs conditions progress or status? Dimnnsion 3: Brief comment addr sing ema?onai, comp?catiom change Dimension4: Bnef comment on pa?ents radium to Dimension Coment strumming use or continued problem potezxtial. reiapse, continued Dimension 6: Comment concerning living environment recovery andlor Other Total$127131. wiry"? 3. 3.1" a. :31 Completed on ?me_ Mental status evaluation (includes ffe?t, Speech, mood, thought judgtammt insi attenticm, concentra?dn, memmy and impl? control Presenting problems includpd' 111 11: t6 Plan campieted . Signed by therapist Total 0 0 0 Day completed (within 72 boom of armit} Page I: All areas ?lled out (Assesem :11: time, marital status, Race. Etlmioity, Religious remodetioos) Page 2: A statement from client on trio they get from using. - . Page 2: All promote ?lled out on out stance use, tobacco Page 2: All areas of abstinence, relax so patterns provided by client Page 2:25.11 areas ofDT?s and ?lled out including designation r1. Page 3: Other compulsive orders pr ?lled out (with i descliption as needed) Page 4: Statement from client about what'was helpful in prior treatments Page 4: Prompts ?lled out complete ly (including ties oription as needed) Page 5: Prompts ?lled out oomple 1y Page 5: Statement from client ahon ?nancial hunden - ?'om ale'ohol or time. use. Page Section oompl ed Ego 7: Biomedical Conditions see ion completed Page 3: Safety risk screening Sthi 11 completed Page 91' Employee Section temple including statements . Page 10: Legal information promp :8 completed a. .- ?age 1 1: Living Ely Support completed ?age 12 Spirituality section comp] eted Page 13: RecreationfLeisme finic- section completed in_oluding statement ofpast octlvi es enjoyed Part 14: Has client been' to the my, it'yes prompts . following are completed Page 15: Sexuality section promp 5 completed Page 16: Statement of goals for tr aannentfhaniers for treatment Page 16: Client statement ofsn?ez g?zs to help achieve oats . . Page 16: All treatmentprompts 6 ?lled out I is signed by pist and client Total . . . .. '5 pl! n'i-L" I .-.1: ne?e- he?- I) ..s. ?on: ., {2:13; L3325 9?1" ?I?I?lea?nent Plan. -.. Problen?lndividualized proble are based on at infonnation ?om assessmentfbio sychosoeial Treatment plan has objective i.e. observable and measurable goals - The goal(s) is based on. the prob. em statement Objectives are memoir: and [early state what the patient will do to achieve the go Intarventions identify how the stiff Iill assist patient Frequency, Amount, Duration, and, hldicated for each intervention ta??mponsibie are: Plan identi?eshow goal attainme?fi 3 to bemeaaured Sueng?lszarriers identi?ed Quality ofkeatnent plan is present There is evidence?that the treatment relevant: ad?ressca issues ralevanttc religion, efhhicity, age, gender, saxu aim is cuin?a?y . the cumllca's ra?e, a] orientation, level of education, sonic-economic level. prresented, ismlas are addressed .1 All signatui?c? are ?lled in (client and therapists) Target dates and achiewl dates are ?lled in as appli?able Tami 0 0" 7112'": Tit" aw . . matinent Planlagsdai?a .: -- high-:14?. . ?15. areas: .. 'gbl?e: - . I 1 3.Assessment ofclie?t pmgress?hem is at least one statement wi?lin client magmas sec 'on that mamas . 1 whethar aa??sn'ategi has or has no been Completed or remains in progress. Ifthe strategy inprogress an BXplana?on of what the client has no thus far is vidzd. - Hikers are new or revised 1163:1113 gaals (compare to original treatment plan) they should a. listed under new/mvbed treatment goal and 11,deth at the top of the {remnant - It?pmmedwith 3 issues it is addressed in the treatment pian 11de Ire All data; and signatures an: ?lled in [therapists and client) Total 0 0 nu. Audit Dafe: - Au?ditor: CM: Therapist: Supervisee: Supervisor: . At?tudg safety Team Approach Timeiiness of Documenmlan [3 Attendance and Punmaltty Time Management Professional! Gram and RCA Mission, Vision, and Vaiues CI Professionai Standards- (haundades, etl?cs, etc.) Management Pubic? Procedure of Assessment and Skin El Can: Notes [3 Planning Raspunse to Ginlcal ?utmmes [j cas?pgci?c Supervision Review issues Famifv Therapy Group Therapy a individual Therap}; Evidence Based interventions Patient Experience Supervisidn Log Start Time: End 11 mp: Vii-cand?s No Show Rate Length ofStay. El Praductlvity CI Administration Training Job Duties SurveyfAudlt High RISE: cases or concerns 53:5.? - . . a .3, Progress Notes: Assessments: Treatment Pkans; supewlsee Signature Supervisor Signature L?cist Reuisinn: 10121116 11.2.15 EI. Recovery Gaiters qumorioa R55 Facilitator Auditing Protocol All auditsiuisupervisi logs, and dis?ipiinary action forms are to be maintainod withi? the empioyeo?? fiie. - For ease of reference and'continuity, it is race :32 . . ,4 additional speci?c to each RSS. 14 855 SupervisorfCiin cal Coordinator is rospon a. At minimum two audits per 383 st b. RSS'Superv sor/Cllnic'al Coordina 212 ensure faci Itator competency aura . -. 3 c. Quarters; . i. Q, rter-rter 3: Juiv? . iv. 2 - . 11-5-1. . 2. R55 Supengis seminar/workshop to be audited appropriate 51:2. ?4 Checklist .l'sion Checklist I envision Checklist . Su?! _sion 9 Sup?rvision Checklist . It chad 4r 9' CheckiiSt 3. Audit Checklists anato be completed in entirety to include documenting audit msult of "yes/no?. 4. RSS Supervisor/Cliaicai Coordinator is responsiblo to ensure adherence to thefollowing Performance impnwement Steps forany audit resulting in 'a a. Performance improvement Steps: '11.2.15 prov: as supportive strategies and recommendatiims via 1: 1 coaching to i. Step li?rst auciit resulting' In 355 SupervisorlCiinicai Coordinator improve audit results 1 R55 SupervisoIICiinicai Coordinator audit the some . seminar/workshop within _a one week duration to monitor performance improvement ii: Step {second audit resulting in R55 Supemisorfciinical arra II no for supportive coaching with RCA Ciinioal Training TeaHi- 1. R55 SIIpervIsOIICiinioai Coordinator audit the some seminarfworkshop within a one .we'okduration to monitor performance improvement . Step 3 (third audit resulting in? Coordinator cont hue to provide supports/recommendations for improvement AND initiate "Corrective Action Process. RCA Empioyee Conduii P?bij-cv and Disciplinary ?Actic II Form for guidelines)=- discossaud? Supervision Areasofdis hi. Are ii. Are Ann 1.. RES Supervisor/Clinical audit the some! semi narlworkshop within a. one ?eek duration to monitor performance Improvement -- 3.3 Idfongoi ng [fourth or additional audit resuiting in R55 inicai Coordinator will nominee to provide orig/recommendation; for iiniaroveio?nt A-ND follow additional steps ed in the RCA Employee.? Conduct Policy IRSS SupervisorICiinicei Coordinator will audit the same 1? seminar/Workshop wi?hinxa one week duration to monitor perfonnanco improvement ..- - 'ai Coordinator IniIi share ?ndings of audit with R55 Within an to be documented via RCA in'dividuei supervision Log :ussion to inciude: as of Strength as for Improvement it remit (yes/no) 1. If no, what is fake? Performance improvement Step (see above} 6. RSS SupemisorfCi Holes 2. If no 335 Supervisor/Clinical Coordinator' :5 responsible to complete all forms and procedures outlined per the RCA Corrective Action Process 1 Coordinator will share results of R55 facilitator audits with Ciinical Director during reguidriy scheduled supervision. a. RSS-Superhisor/Clinic if an audit r?s the Clinical Director of audit result and Performance improvement Step ults ?no? RSS SupervisorfCliIIica-l Coordinatorwill immediately notify Ii Coordinator is responsible to arrange -for all necessary supports that may be included within th- a Performance improvement Steps- (1g Coaching, incorporation of RCA Clinical TrainingteamR55 Supervisor/Chm: a! Coordinator Audit Tracker to in ciII do: I 35;: gt"! . d\:\Quartor4: ti 1t}. . Based Corporate Dir?'qtor improvement 's?te?s it RSS Facilitator gudii 11.2.15 RSS name Date of Kiosk '2 9313a rte; 1: tI Quartet 2: ti Quarter 3: tI (I. I . -. Coordmator Is reaponsmle .to email the Qudrteriy R55 Facilitator Audit Tracker to the cii?ic? than 5 days are: the i Directohand the Coroorate. [iirecfor oi glinical Quaiity Assurance no iater close of: the quarterdckendue iaVAPrii acke'I: due by July 5'3? - . other due 5?1? ackor due by. January IIithi'I-I- the Quarterhr R55 Facilitator Audit Tracker, Clinicai Director audior inicai ?oaiity Assurance may recommend additional performance or n3. Roche: wili be reviewed at?Monthiy CIA Meetings. A sses?ment_Evaluatien Dammentotmg 1. Background Data .1143 IEE A Repovery Centers 0f America. Necessag Cilnical Dacumentat'ran Name Age Ethnicity Gender Relationshi 1Leith family, friends, or others Referral So me Date Enter: gTreatment - 2. Gather information about the presenting problem, including history of presenting prqbiem, from the patients erspective and from any additional sunrces available at the time of admission. 3. Must inclu :3 ?why now" factors reiated to their current need for treatment i. happened prior to patient entering treatment? if. De ail patient?s reported stresses - Patient?s ief complaint in their own words History of resenting Iilness Mental Sta us I of functioning his}: of her to self or others Urgent ne 5 Detailed in ormation related to substa?ce use I. Ex lore detailed use of ?all potential substances including but not iimited to: I Akbhol Opiates Sedatives Haiiucinogens Cannabis Stimulants 270:! Renaissance Bivd., 4m Floor, King of Prussia, PA 19406 Tobacco - ll the following related to each substance reportedly used: ii. Bet: Amount 2. FreQUency 3. Route First use . Most recent use Cur ent withdrawal emploms Co rig-1.01.392 Ac Bio Rea Rel Ensure docSafmptom screening 10. _Use of the Clinical e. Recommen 11. Laboratory testing; a. Blood or- (in h. Screenlng? c. Pregnancvl ll. 2701 Elm Rea plicatlons related to substance abuse lntoxlcatloh and/or Withdrawal Potential edical Conditions and Complications ational, Behavioral, or Conditions and Complications diness to Change :pse, Continued Use, or Continued Problem Potentlal every Environment Jmentation on ASAM dimensibns is problemlsafety foCUsed at about each dimension is causing problems related to patient's level of :tloning in daily life}: - at about each dimension would cause safety concern should the patient not I: an inpatlent - using SAMHSA TIP 31 approved screening tool IOWA COWS) astltute Narcotic Assessment for patients with narcotic withdrawal deal by ASAM md Vital Signs ne tested for abnonnelitles 3r infectious disease? HIV or Help esting I Renaissance Blvd., Floor, King of Prussla, PA 19406 Continuin Car Doc entail 1. Documentation :11 ust indicate ?Active Treatment" a. Documen. atlon from each discipline (Therapy, Nursing, Medical Case Management) must reflect patient contact and content of- contact is. Treatme plan is formulated based on the "why now? factors leading to admission. ais are clearly established are objective, measurable, and include the I. dent?s baseline. - ii; egress, or lack thereof toward reaching each goal is documented based ,3 ASAM (see Section 2). pals related to Case Management are detailed on Treatment Plan. .. Patient i altement? in scheduled patient treatment activities is documented is Includes engagement with medical staff in establishing a medicatinn utine, Ail planned medication tit-rations should be cumented. ii. patient is not attending treatment activities for any reason, this is clearly a ocumentediand alternative programming is provided. The patient response to alternative programming is detailed in medical record. fro to engage patient to participate in treatment are documented. 1. This includes engaging patient to include supports in treatment and provide?consent for coordination, of care with current treatment 1 c. i. ii . providers. (1. When cementing ongoing problems that are being addresSed in treatment, an interve ion to address-the problem needs to be documented as well. re. Case agernent is actively occurring'and is documented. 1. atient?s family and other natural supports are contacted for collateral . formation and said information is dooumented for treatment plan. 1. Consent is provided and contact is made with supports such as, but not limited to: Family b. Recovery Network . c. Outpatient Providers d. - Case Management services through the insurance company - or community provider e. PCP f- Sober living houses 2 Plan fer family sessions are established 3. Ongoing coordination with supports is documented Community resources to be utilized at discharge are located and secured. . This can include: 1. Sober Housing 2 Vocational Counseling -- 3. MINA groups 4. Outpatient appointments/step down plan 2. ASAM Note (Stuntman: for UR Review) 2701 Renaissance Bind. Floor, King of Prussia, PA 19406 8. Become "at medical necessity related to all 6 ASAM Dimensions ruminant risk related to each dimension as applicable document assessment reiated to each dimension and include remaining safety :oncerns) 1 regress made toward goals related to each dimension in specific, neasurabie terms. identify continued plan to help patient achieve goals identi?ed on treatment plan. Document in detail If patient has not made progress toward goal related to insert! and identi?ed new goals for patient to work towards. Document, in detail, any new problems that hone arisen during the course of treatment and identified goals listed on treatment plan. b. Considerations for documentation on each dimension 270i Dimension 1: Acute intoxication/Withdrawal 1. Remaining signs of withdrawal? Are there postwacute withdrawal still evident and needing treatment? (Fatigue, dizzineSs, nausea, 'etc. i A 2. Vital signs 3. Plan for intervention related to continued withdrawal 4. What rs the risk related to early discharge with these . present? 5. ?Continued monitoring needed due Dimension 2: Biomedical Conditions and Complications 1. Have patient?s physical illness Issues been addressed in treatment? What medical illnesses are being actively treated based on the treatment plan and medication orders? . 2. what treatment complications are present due to cooccorring medical issues? (eg, physical pain causing patient to be unable to attend all groups and is being actively treated Expectation that pain will resoive within a few days and patient will he encouraged to attend full schedule atthat time. 3. What? Is the continued multidiscipiinary plan to resolve the present complications? (eg, ongoing evaluation by medical staff and/or oonti inued needed in order to help patient obtain Insight into managing diabetes as resulting trigger - patient to crave USE. 4. Has Case Manager coordinated with current outpatient treatment . providers? 5. Has Case Manager obtained records from recent previous providers? I?iow has this been incorporated into the treatment plan? 6. Does Care Manager need to schedule discharge appointments and . transportation plan for patient?s medical condition to he addressed post discharge? . l_RenaiSsa nee Floor, King of Pressia, PA 19406 I iv. 2701i Dimension 3: Emotional Behavioral, or Cognitive Conditions and templications - - What chronic or acute conditions are being treated In. accordance with the treatment plan? 2. What progress has been made towards treatment goals in - I measurable, speci?c terms? 3. Risk related to premature discharge- what continued treatrnent needs to occur in order to ensure successful transition to next level of care (how is patient going to manage Ctr-occurring ptoms)? 4. is patient currently able to manage activities of daily living? What' is the plan to improve patients leVeI of functioning? 5. Has?the Case Manager coordinated with current outside providers? is this information incorporated into the'current treatment pian, if indicated? 6: :1 Does the Case Manager need to onerdinate a safe discharge plan that includes follow up for pondition? Dimension 4: Readiness to Change Gaels 1 How has patient progressed in their readiness to change since admission? 2. What is the risk associated with discharging patient prematurely due to their current status? a. Does patient Jack insight/present with continued resistance which would cause risk to themselves or others if discharged? 3. What speci?c goals are being worked on to facilitate impressed readiness to chan'ge? a was: interventions are being utilized? What has worked in treatment thus far? Has Case Ma pager/Therapist scheduied a famil},r session for the famliy therapist and patient?amily? Dimension 5: Heiapse, Con?rmed Use, or Continued Problem Potential Goals 1 What .f?here and new? concerns does the treatment team and patient haire reiated to potential for reiapse? a. What specific goals are'detailed on the treatment plan to help increase reiapse prevention 2. What programmatic components are being implemented that will best assist patient in the moment? a. Specific types of groups coming up in the next few days, . upcoming family meetings, additional support meetings . 3. Has the Case Manager coordinated a safe diacharge plan with the patient in order to assist with relapse prevention? a. Schedule appropriate step down appointments lb. Scheduled transportation Renaissance Blvd, rim?Floor, King of Prussia, PA 13406? VL 3. Progress towarc a. Adatab i. ii.- iv. y. b. Coordin informs c. Medina d. Family 5 2701 c. Coordinated with all sopports about continUed care plan post discharge . 4. What risk is indicated should high potential for relapse continue to exist? Dimension 6: Recoveryftiving Environment Goats 1. What supports have been established over the course of treatment? a. Case Manager has coordinated with supports and has updatedlthem on treatment progress in. if this has not been established, continued plan is to work on further enhancing natural and community supports c. case Manager has completed referrais for patient needing support in their community early in treatment shouid the patient report a lack of natural support. Can the Community Supports identi?ed come in for a meeting prior to patient discharge to establish rapport? 2. Wh at resources have been put in place for aftercare? What needs continue to require attention following discharge to ensure safe living situation. . . a. Aftercare appointm ants in. intensive Case Management (either community based or through the Insurance company} Sober living house d. Vocational planning e. Financial resources . Transportation g. Childcare- h. ANNA meetings i. support needs 3. What risks are present should any[ of these steps not occur? a. How would a lack of planning on Dimension 6 impact successful treatment completion? Case Management goals related to Discharge Planning arse of supports is obtained and inciudesr Consent for coordination of care Phone number Email addresses Relationship to patient inclrides list of individuals that patient has used with in the past, and friends, that can identify patient?s whereabouts in case of an emergency ation with each support identified' 15 completed and ail collateral tion related to patients ailments and history" is documented records from previous treating facilities are obtained ession is scheduled Renaissance Blvd, Floor, King of Prussia, PA 19485 Ae. Initial difarge pian is developed 1. eferrals made to aftercare resources [see 2.113112} f. Summer of Case Management Plan is in chart _2701 Renaissance Blvd.) Finer, King of Prussia, PA 19405 Agenda: Chart Audits Avatar functionalitv Real Time vs. retroaitive chart auditing Role of chart auditing in LOS and survevfaudit prep Quantitative, Qualitative Continuity of Documentation, Service Bellman: 0 RCA expectations 0 00000 Staff responsibility 0 0 Role of?QA Role of cliniiai sopewisory Role of U8 chart audit . RCA CM Ad in Supervision ?CM.Therap Easic Requirements Treatment am Sapewision rotocoi Case Maria merit Protocol Documenti for insurance Auditing of ne? 5 own charts {awareness of what is complete/what' is missing) Collaborati to ensure comprehensive documentation In chart across multiple practices (b completion, treatment plan development continuing care plan developme t, casermanagement protocol, treatment team) Responsive ass to group and Individual feedback (supervision, treatment team) I Cr tion of auditing processitrackers/schedule as necessary ereoce to guidelines Tre atment team agenda 0 Cm ITherapigt Basic Requirements 0 Treatment Team . 51: envision Protocol 0 Ca Management Protocol Do umenting for Insurance Cii ital Trainings Real time and structured (supervision) feedback Staff accou ritaizoiilty and growth to include preparation and delivery of supports for staff progress (lJr increased supervision, additional training, etc). 0 0 Chart View 0 Quantita??v, mgnagement reports gm?iidilmizhg: 3? .I'Taf; .- . {jocumen?tioh must axi'?l in. p?uti-mei??ai realm! i'rafiqq?'n. '-"ria21s . . - . I . hm?) g?g??v I Therapist: ?mnpiate TherapistFinaiize i .93 i313 ADMESSION Bio masonia-lfor?etox Bin 5 mosociai. 332?63% Therapist and Case Manager 24-323? - . - begin gathering data for 4 ate of 5 {@533 Tmatrnent Planning whine-s Treatment Plan mam?ntmn for . Eff; 1? 5cm? Md hours after admlsa?wn ?nalized. coli?ct data Detox Due Eng}? Treatmant Plan ?nalized for -- ?i?yg? MD 1- .. {?Therapist. Obtains mnsentif TherapistiFamliy 3-. Admissions unable. Inmate . . . ?is -- 5 - . Therapist. Ensure inmaiFamiiy ?ssissions cohrgact ini?aiFSis Sassian empietad 2* a noonsen. co - ed led riarta foraiileueisofaara. 14% -. information. Schedule Famity Say - - 3? $353k?? (F8). a; ?35 .. 3-31. - ., .- - . Therapist AND 1: 3335;? 5?ng Q-r . 9m?? anoup 3533:0149 Completed ist 2..- Egg 1. gig 1mm?? nocumsump Session on or prior AND Egg . mp FDRMAT . - to Day? 3?3 1 - '4 'ta'v- 1? admisszorx ., - . T. THERAPYH y: I: y? - 2 REQQIREHENJS Eon i?i?xwi .. r. - mcymeujymou' ._gfggi gag?? fagegg-i; . - l. . Therapist: Updated . . 3:31 . ., Therapistmust ABM note: - .3: "1 3 ?2 updataASAM note compieted on day 3 . @111? Egg Gamma? -, 51h day for 7(sama farPC} and ?3 .., . Fl?- it?? upon admission Detox and at ?ma bafora alum 2,53: ?i .. ofstepdown scheduled UR . . revimv 14 Case ?Rugge?cmm?am CM: Qahiinua Therapisermuide . - Admissions to Omsk? n9 {fans}; I attempisto mutant Update an sf. obtain consent aigfim?gf?igr?edizg formilai?rai treatment progress . - rewards to inform TX Plan . information 1200 empis . i - CM:DiswssIon CM?fdicnccuan - naxtTdayS, 4: . . Case Manager (GM): with pakentof continue 10 develop possible patient discharge Con?nuing Gare pm and aim to set 1' needs Ha" :if?urpose, up a?amare etc. mea?ngs. .3: l' . Admissions preliminary diagna?a Monica}: con?rms andIor modi?es diagnosis atlima 43f medical assessment. Therapist: review and con?rm diagnosis as part of ?naiimtion of 139311119111 plan Therapist mum and con??DS diagnosis as part of ?nalization of treatment pian nu, c_ 13.5.? 14 . :0?wa Fagijarg-I.? v? -. .. A. 3 Treatment Plan. Updates due every . 15 days. due. ?Updaf 351196de prion?o day ?1 Jhdicafad Treatment? Update Wampls?Famin Therapist: Schedule 2nd F3 if indicated. ifdlc is to be slated, schedule DIG Family Sassian Miami: I dammit; contact ME I Family (ongoing) up: 'afe every 90 da (3 Ensure weakly updates from . progress, concerns documentation of family: teament Session on or ?rior to Day Thampisi: Cur spit-?33 2nd 14 'Compieted ln?ividunl Sessidn aVery 1* days. Therapist {emulates plan :5 have a safe discharge. that enables: client . iransis?ori day of Therapist: Upmted ASAM noie compleia Ion day 14 and ism-for! every acheduled maria?! Therapm: before every scheduted UR Review completing every? . days ongoing and - . . - .-.4?GMH?herap] ?F'rovide Weekiy upda . toOP Provl rs I ??ngaing Weakiy Updabes CM: Gun?nua scheduling a?arcara, set up phone calls Him Pa?ent?and aftercare providers to establish rapport. GM Establish pian. Meetw?rt Pt24 hours prior to scharga to review plan. piale Continuing Ca Papanmdn will fuiluw up with afterca provider no laterthan 3' eye: data of schadu appointment. TCU Getting Motivated to Change Supervision Checklist Supervisor Name: StaffNamo: -- Daio: - Criteria Mot NotMet Facilitator was set?up and premrod 10 motes prior to session start Fagi'tatorzhad su?cmt one workshoots fonafl group participants 5-35 - Facilitator Wolcomed each mot . . 111m a; . . . F116 @1331 -. .1 4:71:32" I . participant 5f J. 33.: 's 1.1: 'l I . 503:515-..- Faoilitator actively moderated group discussions, coming no one pa:tioip ant dominatod tho isonvorsation FF ilitaiquopt?la'gmup I?i-r gm I - - Facilitator. provided time for gimp participants to complete maps and worksheets indep on: on?y how oftho next 3653: -, ., 3n . I 3o?: used Target Lo deg the group shook?in l. Facilitator asked group part ?What. 15 tho ?rst on w?f do tower}: .on- yourio: @53ng Ru :1 - as, - IP?nt Medication-Assisted Treatmentin Opioid Addiction? Con?rmation 335182046 - emm'mlrasmi' 313112017 We - 598?Compliam; (WW 59) public hearth com. Its on individuals, as we]! as pspula?ms, is course is targeted In a hmad hsaf?mate audleme, Including I more advancsd levels of meditation-assisted trss?nsnt magmas. By problem and giving the de?nltions of opiates and the processes ls training 'd lscusses the p?nciplm sf effectm . 33 emphasis on assessing the mad?addicted 1ndeuaI seeks (are. Using various Wing tods, Including information and interactive exa?ses, this mums win help you 13;: formulate a plan cars, gaalsfor rsasvsw, and osn?dmtlaiity guidelines fur individuais seeking treatment in your an setting. guidelines derived from the 511an Abuse and Mental Health Swims Admi istfa?on?s (SAMHSA) ?Medication-assisted manuals for opioid addiction: Fads far families and friends ?will ?irthsir assist your Earning and applim?on of 1119.93 summits. This course is for anyun?s who may be Involved with the tsa?nent of upidd addic?m. - Opinid addic?m is a signi? are qxs?y and burdensome. Iritividuals with either basic dearty de?ning the scope of - Involved in opiate adc?c?on, addictian treatment, with, COURSE Outline - Section . A: About'fhis Course . B. Laaming Objectives . in CMareAmetOpioid D. Whatm?e prld?? - Eouatesand?ie Opioid Addiction - I. Canrmn Terms In 3. Test Your Knuw?edga - K?Sec?on Summary Section 3: Meatloa- A Treatment for E. Let's Pmc?ce the - F. What is Medication Isted Twatment - N. Ta any a Meditation for Opioid'Addicaon . - 0. the Steps for Ensuring Safe Medicatian Use a P. Side Effects anedlm?Gn . Q. Common Side and Simple Ways to Reduce Them R. Adjusting Madka?am S. Course of Treahneri: . T. MAT ngrams Are 0 U. Test Ynur Knowted . V. Michael's Medlmti . W. Secuan' Summary-- Section ?Wi?Em-mf, mg! Con?dentiality' A. Assessing the . . Introdudng Med] . . - C. Asmdai?d Medical Pmblems in Female Who Are Opioid D. The Individualized Plan of Care . E. Counseling .0 F. Familyand Fliends I G.'SupportGmups re Bubortanl: Too! i H. Goals for Recovery rri Opioid Addiction er- I. Lets Piactlce Deva! a Plan of Care . J. Cun?denliallty Gui lnes - . K. Con?dm?allty and "vacy S?ecl?cto Opioid Treatmeni: L. Things in Remembe M.RaihelContinLIed_. . . N. Section Summary simian 5: Conduddn . A. Summary .. B. Resources 9 C. Refera'rces About Opioid Addiction and Treatment . Leamlng'?bjectives Discuss-the self-manag?mnt Emilie-?re four a 't?mniques yau .canemjsloy in safely administer medlwlians for upliald . to withdraw from the problem opioid. . are elements or addictionzformulaia goals with the individual who Wams . Mditiorlal Infunnation Expert Waiver FAAN Luz: Pelle?er MEN, EPRN, BC, Mr. Pellelia', Essential Leaml the behavioral healthcam ?el and is a licensed emertise is in the areas of waged behavioral hie-af?rm ,?mental health and addlc?ans nursing, clinical infunnatlcs, quality and perfom?noe impmiremmt, quality, policy development, and acmed?rlatlm and-regulatory Compliance. Mr. Palle?er has impressive edlm?al mums: as armor, contributor or revlewer for- premier nursing jaumal'o} He peer?reviewed journal of the I Award of Emellenoe in many: Madam of Nursing, the Natl Mental Healkh Administration. Dlsdosura: Luc Panama-r MSN, Financial Ell? Rele: wrrently the Eelitcv-in?Chlr?= of the Journal ibr Healthcare Quality, 3 'la?anal Assnda?nn for Quality arid the recipient of the APE Labegories since 2002. Mr. Pelle?er is a Fellcw with the Amman anal Mgcm?bn fer Healtl?rcare Quality and the America College of Apr-rm, 3c, mm has dedared that'na mn?lct or-inberast, Relevant mntNan??nandal Relationship exists. . . .A g?s Senior Healihcare Quality Cansuitant, has 217 yam of experienoa in . Hon?bun.? . Staff Writer Steve Jenio?ns, Dr. Steve Jenkins; Phi), is 3 ?inches Mensive clinical ex college counseling genters, Wo?cshom and trainings on I counseling psymologist and a professor at Wagner College in New York oertise working in a variety of behavioral healthcare settings, indedirIg omatient dialog, hospitals, and motions facilities. He has developed and best premiere in evidence?timed individual and group psymotherapy. Dr Jenkins is an associate fellow and completed, his post-doctoial training at the Albert Ellis Institute for Ratio health cognitive He haebeen. published lri top Counseling,'The Counseling Quarterly. Dr. Jehidna also re Disclosure: Sieve Jerkins, Pt or Reieva ni: Non Target Wimoe The target audience for?rls and immediate level Nurse intermediate lavel Social Human Services, Hospital, General Nursing, Gemntologr Relies teaming has a g?evar will make every etfert to rest complaint or grievance pleas nal Emotive Behavioral Therapy. His primary research interests are sleet), behavioral ?ierapy, multimluiralismidiversity, and poal?ve paydiology jounials and books including the Journal of College ?sydiolegist, mammperary Family Themy and Counseling rguiariy preaonts his at national mnfaierioes; ii). has declared that no mn?id: of interest, Relevant Financial ?nancial Relationship exists. marge is: entry and intermediate levei Noohol and Drug Counselors; entry . 5; entry and intennediaoe {ever Professioml Counselors; entry and re; entry latte! in the following settings: Health and and the following predicts rategerles: Addictions Home Health, Mental Health Pain Management. - roe pelioy In place to facilitate reports of dissatisfactim. Relias Learning rive ead1 grievance in a mumaiiy satisfactory manner. In order to report a a coolant Relies Learning at support?reliasleamlng.com If you require spade! ammdaijons to complete this modtile, please contact Relies Learning Grommet Support by calling- To earn con?nuing eduta?or post-test and maplete the (891)) 3814321 or emailing support?reliaslea mingtcom. Credit for this course you must amieve a passing attire of seat on the some evaluation. Reviews Module: Triggers and Cravings Components Icebreaker Activities Sticky moments Videos Materials Needed Dry Erase White Board Dry Erase Markers Triggers and Cravings 1 minute introduce seminar Recovery (hide 3 minutes What is the difference between a trigger and a craving? Trigger leads to a craving. use coping to help ease the craving from turning into relapse. Objestives 2 minutes De?ne what a trigger is and types of triggers Learn where a creving comes from end what it does to your brain. Recognize how triggers lead to cravings. identify ways to cope with triggers and cravings. Ciassicai Conditioning 3 minutes introdUCe concept of ciassicai conditioning Reference Pavlov's experiment Video Human brains are wired to help us remember pleasurable experiences- - Pairings of pieesurahie experiences become automatic responses with repeated conditioning over time. The same process appiies to addiction and when we use substances. Training the Brain 2 minutes The intensity of the ??zing' between the thought of the activity and the pieasure receptor creates a deep connection (superhighway) Thinking about using the substance can hig hiighi: the receptor, giving Us a taste of the high without even using. What is a Trigger? 3 minutes Define a trigger. Triggers can be anything that the addicted brain associates with the reward of getting high Triggers may cause a person to relapse or engage in a behavior theirr are trying to avoid. Triggers Are Based 2 . minutes Triggers can he created from anything (.2 g. dates demographics, personal preferences behaviors and internal I and external factors). 9 8. Types of Triggers .2 . minutes internal triggers: inside of Us {thoughts emotions or physical sensations) Externei triggers: outside of us (people, places. things and . situations. Narcan?? inaloxone) gIVas concerned helpers a wlndow of to save a life by providing extra tlme to call 911 and carry out rescue breathing and ?rst aid until Emergency. medical help arrives. zel Triggers and Recovery 1 minutes . Learning the processes of triggers and cravings can help you identify ways to cope with them . By lea ming how to your personal triggers, If implementing an action plan to stop the trigger, and learning how to stop the craving from turning Into relapse minimizes risk and promotes healthy living. with-ms? 10:: . . . -. 33in It .mw??a'mmbm wm'? mm Emma BEE .ru?w. ?Hem car-1m A RECC . A . 1 CENTERS COMPANY HANDBOOK 9 Village ?Inn Road W?stminster, MA 014% . . (978) 571?6050 Our program combines primary counselor, you needs, abilities and prefe noes Together we will create a personalized plan for your recovery Hello, .. Welcome to Recovery Ce: tors of America (RCA) at Westminster we?re glad you have trusted . us With your care. Weston ester is a campus specializing in treating alcohol, opiates and other substances, and co-o :curring disordezs. An expert team of physicIans and other professionals will preside compassionate, scienti?cally proven effective treatment amid top . notch, ?ve-star accommodations, chef prepared farm to table food, the most comfortable mattresses and bedding, 1n the beauti?zl head of New England. Substance Use Disorders are a chronic, life~threatening disease that diminishes the quality of life for you and your family. We applaud your decision to enter and understand it may not - have been an easy one. This handbook is designed to familiarize you with all of the services and resources available to j. you. We want you to feel at home and comfortable during your stay and know that it is our goal - to treat you with a Susie: patience Please let any Westminster staff member know if you hate any questions Anew pa at orientation occurs within 24 hears of admission integrated approach to Substance Use Disorder treatment With your ltailor an individualized course. of treatment based on your that will include individ and group counseling, medical and sendces, life skills development, workshops leisure activities, physical education, relaxation techniques, yoga, 'The Treatment Team cons: massage, mild, coupons Disorder treannent, Nurse Level Clinical Leadership, and certi?ed holistic pract Family recGVery is an imp - have regular phone contae: and visits according to yo family educations sessions and family counseling. sis of Board Certi?ed Physicians skilled in Substance Use Practitioners, RegiStered Nurses, Licensed Practical Nurses, Doctoral Masters Level Licensed Clinicians, and Recovery Support Specialists, tioners. I orient part of the recovery process. You and your family therapist will with your chosen family members and will schedule family counseling or individualizedplen. Our family program also includes 12 hours of available indie evenings or weekends, and a family community support group open to all Wednesday evenings from 6: 30pm?8: {30pm Westminster employees die a dedicated, knowledgeable and professional team We are here for you, yota? health and the We wish saith of those you love you success with your treatment, recovery and health. nu-? mun?II DITATI Westminster is accredited by The Joint Commission.- Westminster is also licensed by the Massachusetts Deparhnel 11; of Public Health,.the Commonwealth of Massachusetts Boxeau of Substance Abuse Service the Drug Enforcement Agency, and the Substance abuse and Mental Health Services Administ a?on. 5 - We believe that people 2?cring ?om the disease of addiction can recover. Our mission is to save lixresiby heating ad tion with evidence based neannent services and ongoing recovexy support. Though our adv easy work, we will become a disruptiVe force for change, reversing the stigma of addiction an 1 those who su?hr from it. W1 - I We will develop an innovative clinical treatment program which integrates 'the leading research and technology in the ?eldlwill shift the focus from remote treaanent centers to where the entire . community is engaged in covery. This neighborhood model -.will encourage education and create Opportunity for [wig change. We will be a dismptive force for change. As chamlaions for our patients and their families we will use the legal system to ?ght inadequate care whereby insanelme companies dictate poor treahnent. - . - i We provide you with a 3y of-yoor individual schedole each day. It is also posted on each unit and in common spaces. Jf you have questions about your schedule, please ask your primary therapist for assistance. - I ?1 .1 7 Westminster has an unwai axing comminnent to our patient?s health, safety, and well-being. We believe you haVethe right to a safe and secure environment, ?ee from, alcohol and other'moocln ., altering substances. Our mission to provide the absolute best treatment, with the highest level of safety and security, begins with a drug-?ee campus. For the safety and security of all Wesnainster patients, we expect you to respect this commitment and help keep a drug ?fee environment. Pomov To eosore that Westminster provides a drugfaleohol ?ee, and safe environment for our patients, staff and all visitors, 11pm admission and entering the facility from any outside appointment, we will eonduet the following: a An inventory of a i belongings brought into the facility Any items that are not appropriate I - (I in a treatment facility will be returned home, stored or discarded- A search ofhags and belongings brought into the facility upon veer retum from any outside events I A medical safety a An room search of patients. rooms or other possessions if reasonable . suspicion exists. W: Dmgsa search. upon admission :reens are conducted at the time of admission, upon return from any off campus ?events, and randomly during the coorse of treatment to verify abstinence or in cases where substance use 1 Recovery Centers of Am Recovery Centers of outpatient sendces. Thee fee so ale policy. Reduoec Customary charges. Acute Treatment Servil ATS programs are medic .nurshag care, under the o1 from alcohol and other (It Human Services, 2016). suspected FEE POLICY a?ca accepts most major commercial insoranoe plans. rice may in certain instances, provide redeced fees for inpatient and are determined on a case?hy-oase and subject to the company? sliding fees are calculated based on a discount of the Facility 5 Usual and LEVELS OF CARE .ee (ATS) (Detoxi?cation) ally monitored detoxi?catioo services Programs provide 24~hour msultation of amedieal director, to monitor an individual?s withdrawal rugs and alleviate (Massachusetts Deparoneat of Health and When patients have completed the detoxi?cation process they are medically cleared and to a lower level of care. Clinical Stabilization 5 CSS offets 24~hour he rviees (CSS) ent, usually following Acute Treatment Services (ATS) for substance abuse Typically, clients stay in the program for 10~i4 days doling which they receive a range of services including nursng, intensive education, and counseling regatdiog the nature of the I addiction and its conseqt . beginning to engage in It eaees, relapse prevention and a?ereaxe planning for individuals eovery from addictioxi. These programs provide mul?diseiplinary 1 treatment interveotions apd emphasize individual group and family Linkage to aftercare, relapse prevention services, and It is yollr rosponsibillty to Please avoid the use of p11 Staffm?mhei?a are always sessions and during your 1 has a zero tolerance pollci You are responsible to att: remain until the end ofthi: Please hiring your pen and -help groups, such as AA and NA, are integrated into treatment and discharge planning (Mass iohasetts Department of Health and Human Services, 2016). co on treat other residents and staff with respect and dignitv at all times. )?lnity aVallable to discuss feelings of anger or ??sa'ation in individual rroup meetings. In order to ensure a safe environment Westminster for any type of assaultive or threatening behavior and all activities, groom, and lZuStepjineetings, anive on thne and I session unless medical or clinical staffhatre approved year abSence. notebook with yon to each group, meeting,;and counseling session! Gambling. in or on Westmr?nster property is not permitted. Shoes must be worn at 21111 Patients are only allowed times. to enter their asSigned bedroomf For your safety, ataffroutinely Ieheck bedro oins at various times. For your convenience, we have provided designated smoking areas at the ?re pit and" in the healing garden. Please smoke" In these areas only. It is prohibited to borrow clothes or any other possessions from other patients. Sexual/romantic relationships are not permitted doting your stay at Weshninster. Television and cell phone management a residential unit allows for of?ce. I Residents are not 2 Westminster reserveethe 1 violence, substance use on or other patients at link. It appeal. The process is on! use is only allowed during designatedfnonwaotivity time. While in the nit, cell phone use and telephone calls must be approved?by Staff. The additional supervised phone use scheduled each evening in the R83 ?owed to carry their cell phones. I ight to adn?nistratively discharge any patient due to physical or eeimal campus, andfor other Similar behavior that puts them, our employees 'a patient is administratively discharged, they have the right to an I lined in the Patient Grievance procedures in this handbook. We recognize and appreciate the value of your loved ones being involved in your and-their own recovery. Therefore, we encourage you to spend time together. 3 Visiting hours are: a Tuesday6:30pm?8 00pm A. 3- . Saturday 1:00pm?3 :oopm - Sandayl:00pm?3:ti0pm I - "i Visiting locations include the family and admission lounges, as well as the Great Room, if necessary. In addition, we have a family therapist and individual therapists available throughout the weekends and evening: as well as other support sta?, to assist your family in their needs. Please discuss with you: axy 'l?herapist any visitation questions 'or connotes. To ensure patient safety, all visitors need to on your Approved Visitors,List,'whicl1 can he" initiated and updated with your Primary Therapi. gt. - Please note that visitatior is deteonined on a case by case basis while in the withdrawal management ptogtam. . - ,f Hesse let your visitors k?Tiw that there are certain procedures we follow for their comfort and safety including: 9 Ask visitors for id nti?cation; 0 Inspect all inoo packages; a Allow visitation in approved areas; 6 Ask that handbags electronic devices, mohile?phones and food and drink re in cars. FAMLY PRO GRAM- Substance Use Disorder is at powerful that it never affects just one person; the entire family system is hurt. In addition, the system can either serve as a trigger for substance use, or as a support for recoveryc'i?he success in treating Substance Use Disorders goes up dramatically if the most signi?cant people in your li?e are involved with you in treatment. Westminster acknowledges this and gives high important Westminster?s Fondly ng disorder, get support for the Weshninster?s Fan?ly'l?rogl :e to providing a comprehensive and quality family program, ram makes it possible for family members to gain perspective on this nselves, and learn new ways of supporting their10ved one?s recovery. ram: .. mun. 0' Provides up hours of education, therapy and support to those family members who have been Moises to their loved one? 5 Substance Use Disorder. it Is open to family embers, spouses and signi?cant others ages 15 and older, and takes place' 111 the Great oom or a smaller gronp room, if available. a Our family comm ty support group is open to all, including family members of past and current Wes evenings from 6 or patients, as well as the local community It runs on Wednesday pin-8:00pm. This group is professionally facilitated :?but member run. Participating family members share concerns, questions, support; wisdom, strength, and hope. 0 Educational sessions are open to all family members of past and current Westminster patients. These 'grt pm. and ?oor 1:00 ups are provided on Saturdays and Sundays from 9 :00 are. to 12: 00 to 4:00 pm. They are also provided evenings . . from 7:00 to 10:00pm. The sessions are cycled so that participants can compiete all 4 modi?es within a weekend, aoross 4 weeknights, or a period of 1, 2, 3, or 4 weeks. In addition to these family and support group offerings; your Primary Therapist andfor Family Therapist will encourage Ind arrange personal family and couples therapy sessions throughout your treatment as needed. Please discuss ?thisiaspeet participate. It will easey fthe program staff and encourage your fan?lylsapport group to transition home and enhance your recovery. . The TriggR Health smartp one platform is a great tool for you to..utilize in your recovery. It combines encouragement, opport, and accountability and provides an amazing opportunity for - you to track and manage or own sobriety. TriggR will help you to: a Track your daily gross and celebrate your accomplishments Better assess three to your reoovery and track triggers I Provide 24 hour/7 - Locate nearby rose. ys a week rea1~tin1e therapeutic support ings and/or treatment supports a Stay in contact with others in recovery Increase your await. mess of mood changes, stressors, and Case Management staff will be meeting with you during your stay to talk more about this opportunity and assist you with the sign up process. PATIENT PORTAL The Patient Portal sniaitpllone platform 13 an interactive program for you to utilize during and after your treatment stay sense of community, eolla details. Communicate View your eeheo View your trieatt View past and Access the patio All patients may send and. It allows you to actively engage in your recovery while maintaining a borate with peers and treatment team staff, and review treatment This initiative is in process. The Patient Portal will help you to: ith your health care ptofeseionals ole dent plan goals, objectives and interventions ent medications Access and Com lete educational worksheets Track your dail mood and days sober handbook EN receive personal correspondences. Outgoing mail can be dropped off to the receptionist. Westminster will provide postage and mange for pink up All moon?ng mail shall he do on not centain hazardou member, Weshninster will cost to you. We will also 3 . program. EHQI Home phones are available free times. Phoneoalls are limited to . NOTE: The ?rst 5 days 31 during two time. Cell phones will be secure room so they are safe until your personal phones, this made. . opened by the patient with an authorized staff member to ensure it a materials. If you choose not to have your mail opened with a staff send the correspondence or package back to the original sender at no eturn mail to the sender if it is received after you have left the PER LEG RONIC at designated areas on the unit and will be turned on during speci?ed {l-nainntes and may be monitored by Recovery Support Specialists I on will need approval from your Primary Therapist to use the phones Ifyon bring them to tteatinent, we will secure them in a locked the time of discharge. Ifth'ere are instances where you need aooesn to will be approtred by your clinical team and aeeommodations will be - E?Reeders witboet access 10 the intemet are pem?tted during free time. For everyone?s. safety Westminster can?ot be It. valuables not claimed wi SD19 For safety purposes, West designated Smoking areas to smoke. - Patients ere permitted to comfort, valuables, money, jewelry, etc. should be gent heme. poneible for any articles le? on site after discharge. Clotl?ng andfor 30 days of discharge will be donated, 1 ter is a mneke?-ee building. For your convenience, there axe outside. . Please check with a staff member if you are unsure of where 3e e?eigarette?veporizers, however, for the safety of all patients they must bring in new, unopened and labeled e?cigarettes/vapcrizem, bottles of e~1iquids and accesso?es. The charging order to ensure it meets 32 same guidelines as cigare' scheduled breaks. I devices must be?essessed and approved by staff upon admisSien in fety measures. Patients are pem?tted to utilize Vaporizers under the te smoking, outside with sta? in designated smoking area during . Staff will secure e~eigare es and vepo?zere when not being utilized, Patients are not permitted to build their own coils 0 bring any materials with them to build coils durieg their stay. Wax vapes, oil vapee, {1410016 In order to-ensure 21 soon: areas to ensure the safety will there be video met?sit} Your room will be servic and herb vapes are not allowed. a en?mnment, video monitoring will be used at all times in common security and maintenance of athez'apeutio en?ronment. At no time )1"ng in the bathrooms, showers, 01' bedrooms. . ed daily by housekeeping staff. We ask that you keep your room neat. Please do not tape anythin to the walls, lamps and furniture. Please do not remange the fumituie. Monday Sunday Westminster offers laundry facilities All patients are responsible for their personal laundry. Laimdry facility IS located Please speak to your Prim on the ?rst ?u or near the group moms services. Patients are not germitted to perform these services. Tuesday Wednesday I Thursday Friday Saturday VE GS 12-Step or Alternative Meeting wise}; Meeting'or Group Spirima?'w Individual Sphituality 12-?Step Meeting oerreup Spirituality Individual Spirituality 12-Siep Meeting or Group Spirituality Individual Spiriiuality 12~Stee or Alternative Meeting 12~Siep 01' Alternative Meeting IZeStep or Alternative Meetiilg 10 My Therapist if you need It) make arrangements. for professionai 3am . Razors will be stored by sta? and available daily by request to 3338 during ?ree time. 7:09pm 3:00pm 7:00pmm?i??pm 3:00pm 9:00pm 8:00pm 8:00pm 9:00pm 8:00pm 8:00pm~ 9:00pm 7:00pm 8:00pm 7:00pm 3:00pm 7:00pm 8:00p1i1 nun-mama um. mw 1m 3 i In the Rooms Meeting Guide Steps Away .Ea?jl?NT Each?patient receiving services at Westminster shall have the follewing rights: .1. To be noti?ed of rules" and regulations the facility has adopted governing patient . 1r eonduet in the fac' ty. 2. To be informed of erviees available in the facility, ofthe names and professional status of . the pexsennel prev ding aadlor responsible for the patient's care, and of fees and related Charges, including the payrhent, fee, deposit, and refund policy of the facility and any charges for service: not covered by so?xces ofthird-party payment or not covered by the facility's basic rate. - . be informed if facility has anthorized other health care and edueational institutions to participate in pa?eat's treatment, to know the identity and ?metion of these inetim?ons, and to fuse to allow their participation in the patient's treatment. 4. 0 receive ?em th 'patient's physicians or clinical practitioneds), in terms that the patient understands, an ex lanation of his or her complete medicalfhealth condition or diagnosis, reeommentied tree eat, treatment Options, including the Option ofno treatment, risk(s) of heatinent, and exp eted result(s). - . 5. To participate in plainting ?of the patient's care and treatment aid to refuse medication and treatment. 6.. To participate in xperimental research only when the patient. gives infermed, written consent to such 13 'eipa?on, or when a guardian or legally authorized representative gives such consent for imempetent patient in accordance with law, rule and tegl?a?on. '11~ the goreroing an individually or as rcpn'sal, To be ?ee ?oor In: and other patients 1 .9. To right'to con?de 10 To be treated with dignity, individual] privacy ll. To not be required treatment ?and is treatment plan and To voice grievance a or recommended changes on policies and services to facility personnel, ority, and/or outside representatives of the patients choice, either group, free from restraint, interference, coercion, discrimination, or ntal, sexual and physical abuse, exploitation, coercive acts by staff 1nd ?ee from use of reanaints unless restraints are authorised. ntial treannent of information about the patient courtesy, consideration, respect, and with recogintion of the patients ty, and right to privacy, including, hut not limited to, auditory and visual to performlwork for the facility unless the work is part of the patients Jerformed voluntarily, the therapeutic bene?t is documented in the - is otherwise in accordance with local, State, and Federal laws and rules 12. To exercise civil and religious liberties, including the right to independent personal decisions. 13. To? not he discritr - orientation, disabi to pay, or depriVec 14. To be transferred other patients, or 1 failure to pay reqtt by sources of thin inated against because of age, race, roligion, sex, nationality, sexual ity (including but not limited to, blind, deaf, hard of hearing) or ability? I of any constitutional, civil, and/or legal rights. discharged only for medical reasons, for his or her welfare or that of taff upon. written order of a physician, or other licensed clinician or for red fees as agreed by the client at time of admission (except as prohibitetl sporty payment 15. To be noti?ed at tasting and to have the opportunity to appeal on involtmtary discharge - 16. To have access to facility?s policies 1 17. To be named sec 18. To be allowed vi: . plan and, if critic: representative'at 2 in the patients oli 19. To receive prompt and obtain a copy of 111s or her clinical record, in accordance with the and procedures and applicable Federal and State laws and rules. nity in retaining approved personal items as Space permits, unless to?do so would be meals or woldd in?inge upon the rights of other patients iting time at reasonable hours in accordance with the patient treatment ill, to he allowed visits from his or her family or legally authorized my time, unless medically contraindicated as documented by a physician ncal record. medical attention. 12 20. Tohave access to a ropziate education. 1 21. To live in a safe. at and healthy environment. 22.. To be informed of ese rights, as evidenced by the patients written acknowledgement or by documentation staff in the clinical record, that thepatient was o?ered a written copy of these rights and veo a written or verbal explanation of these rights, in terms the patient could understand. . - . 23. Your rights are pro ted under Massachusetts and federal law. A copy ofthe law is available to you up request. In?accordanee with Title VI of the Civil Rights Act of 1964 (42 U.S.C. 00d GER. part 80, Section 504 ofthe Rehabilitation Act of 1973, as amend (28 (1.3.0. 3794): 45 84, Age Diserin?nation Act of 1975, as amended, 5 C.F.R. Part 91,. Westn?nsterdoes not diso?minate on the basis of . race, religion,- sex, xual orientation, color, national Origin, handicap, or age "in admission or acoes to treatment 0: employment in its programs or activities. Your medical record inf ation is protected underdZCER. part 2. . .. PURPOSE: -. Weshninster provides a co dential, non-threatening mechanism for initiation review and, when possible, prempt resolutio of patient complaints'eoneeming the quality of care or service received. All g?evanees stbe submitted in wxiting to be reviewed by the facility?s CEO or their designee. All patios are able to voice grievances hithout fear of reprisal POLICY: . Any patient who has a gri anee of any him} may request a review by the facility. The Grievance Committee, through the ility CEO or their designee; is ieSponsible for effective operation of the grievance process and or the review and resolution of grievances. Ifthe patient sowed has a surrogate decision-maker, or she will he informed of and involved in the complaint resolution process. The G?evanoe mmittee reviews and, when possible, resolves complaints from the patient served and his 1* her family. The Grievance Committee acknowledges receipt of the aeroplane and noti?es the attent served and, when appropriate, his or her faniily of the outcome of the complaint. Each faoility provides the patient served (and when deemed bene?cial, his or her family) with the phonq number and address needed to ?le a complaint with the relevant state audiority. . PROCEDURE: A. Patient No??oatio 1 . The Facility will inform patients, in ?siting, of their right to make complaints and giievanees and the process to do so during the registration/admitting prodess. 13 nun-hm a .. B. Patient Complaints 1 Staff shall enco patients to express any complaints or concerns to the individual invoked and a rapt a resolution 2. If aresola?on at be reaohed, client will ?ll out grievance form. (1- Patient Formal Gri once 1. In. advance of mishmg Care, all patients will be noti?ed of the right to submit a grievance and whom that grievance should he submitted, 2. The CEO or igoee will receive all grievances sabn?tted 3. All complaints at resolved at the department level or if the patient' is not satis?ed will be forward to the CEO via the Department Head. a The ad hoe "evanee Committee will then be convened 'e shall consist of a member of the Clinical Department, another the next two business days and will include: the contact person; by Westminster to investigate the grievance; - 0. Results of 1e grievance process (Westminster ?ndings); and Date of resolution of the grievance. I 8 Weshninster I maintain a ?le on all grievances and their resolution to enable the facility to monitor compliance with this policy. 9 The noti?cation to patients concerning their right to submit a grievance shall include the fact that the patient may address his or her concerns to the state survey agency regardless of whether the hospital?s grievance process is used. The address and telephone 11111111) 3: of the appropriate agency will be provided in writing to the patient. . This notice describes how medical information about you may he used and disclosed, and how you Can get access to this information Please review it carefully. Westrninster?is required by law to maintain the privacy of your health information and to ?rovide 14 prevention services, and discharge planning (Mass It is your responsibility to Pleaseavoid the use of 1311 Staff members are always sessions and during your 1 has a zero tolerance polio} Yon are responsible to att remain until the end of the Please bring your pen and elf?help groups, such as AA and NA, are integtated into treaonent and aohusetts Department Of Health and Human Services, 2016). 00 a treat other. residents bfanity. and staff 'with respect and dignity at all times. . available to discuss feelings of anger or hesitation in individual group meetings. In otder to ensure a safe environment, Westminster for any type of assaultive or threatening behavior. and all activities, groups, and 12~Step ineetings, anive on tone and session Unless medical or clinical staff have approved your absence. notebook with you to each group, meeting, and coanSeling session! Gambling in or on Westnr'nster preperty is not permitted. Shoes must be Worn at all Patients are only allowed . For your safety, sta?'rout For your convenience, we times. :o enter their assigned bedroom: 11er ?eheek bedrooms at varioUs times} have provided designated smoking areas healing garden. Please 5 It is prohibited to borrow? Sexualfroxnantic relation Television and cell phone at the ?repit and in the he in these areas only. lothes or any other possessions ftom other patients. 'ps ate not permitted during your stay at Westminster. use is only allowed during designatedfnomactivity time. While in the ed?ndrawal management unit, cell phone use and telephone cells must be approved by sta??. The residential unit allows-for of?ce. Residents are not: Westminster resetves the 1 violence, substance use on or other patients at risk. I1 additional supervised phone use scheduled each evening in the RES ?owedto carry their eell phones. ight to administratively discharge any patient due to physical or semal campus, andfor other sheila: behavior that puts them, our employees 'a patient is administratively discharged, they have the right to an appeal. The ptoeess is ouilined in the Patient Grievance procedures inthis handbook. 7V1 We recognize and appree' recovery. Therefore, we Visiting hours are: a 6 - Saturday 1:00pm?3 a Sunday l:00pm?3:C Visiting locations include necessary. In addition1 we the weekends and evening: 1 PL te the value of your loved ones being involved in your and their om courage you to Sp?nd time together. 00pm 0013111 99111 the family and admission lounges, as well as the Great Room, if have a family therapist and individual therapists available throughout as well as other support staff, to assist your family in their needef Please discuss with your safety, all visitors need to edth yew: Primaryr Therapi Please note that visitatiox management program. Please let your visitors kn safety including: Ask visitors for idq aty Therapist any visitation questions or concerns. To ensure patient on your Approved VisitorsList, which can be initiated and updated t. . . is determined on a case by case basis while in'the withdrawal or that there are eertain procedures we follow for their comfort and :nti?cation; Inspect all iuco Allow visitation 0 Ask that handbag Substance Use Disorder is is hurt. In addition, the for success signi?cant people in your 1? and gives high impo Wes?ninster?s Family Pro disorder, get support for the: Westminster?e Family Progi electronic devices, mobile phones and food and think packages; in approved areas; remaininonrs. FAMLY PROGRAM powerful that it never affects just one person; the entire family system system can either serve as a trigger for substance use, or as a support in treating Substance Use Disorders goes up dramatically if the most are involved with you in neetxoeet. Wesnnineter acknowledges this to providing a comprehensive and quality family program. ram makes it possible for family membeis to gain perspective on this melves, and learn new ways of supporting their loved one?s recovery. 'ami Provides up to 20 Hours of education, therapy and support to those fartiily memberswho ?have been v?tness 0 their loved oue?s Substance Use Disorder. Is open to family embers, spouses and signi?cant others ages 15 and older, and takes place inthe Great com or a sma?er group room, if available. Our family comm 'ty?support group is open to all, including family members of past er patients, as well as the local community. It runs on Wednesday Educa?o?al seesio are open to all family members of past and current Wesbninster patients. Tbese gr ups are provided on Saundays and Sundays from 9:?0 am. to 12:00 pm. and from. 1:0 to 4:00 pm. They are also presided Monday?hurs?ay, evenings . m. The sessions are cycled so that participants can complete all 4 modules within a weekend, aeross 4 weeknights, or a period of 1, 2, 3, or 4 weeks. I - In addition to these family and support group offerings, your Primary Therapist and/or Family Therapiet will encourage md arrange personal?fam?y and couples therapy sessions throughout your treatmeet asneede?i. . . . - . Please diseues'this aspect the program with staff and encourage your fan?iy/support? group to participate. [t ease)! ueusition home and enhance yom'recovery. . The IriggR Health smartp 1one platform is a great tool for you to utilize in your recovery. It combines encouragement, support, and accountability and provides an aroaziog opporttmity for you to track and manage 3r: )ur own sobriety. TriggR will help you to: I. Track your daily pr egress and celebrate your accomplishmeuts Better assess three to your recovery and track triggers Provide 24 how?? ye a week real-time therapeutic support Locate nearby mee gs and/or treatment supports Stay in contact wi others iu recovery . Increase your awamness of mood changes, stressors, and Case Management sta? wi 1 be meeting with you during your stay to tallcmore about this opportunity and assist you with the sign up process. m. . w. A11 incoming mail shall be . program. made. The Patient'Portal smartp after your treatment stay. sense of community, eoll details- This initiative is - Communicate View your sohe I as 3% its Access and com Track your dail Access the patio All patients may send arid PATIENT PORTAL one platform is an interactive program for you to utilize during and- It allows you to actively engage in your recovery while maintaining 9. hereto with peers and treatment team staff, and review treatment process. ThePatieot Portal will. heIp you to: do your health care professionals ule out plan goals, objectives and mtervea?ons est medic ations lete educational worksheets mood and days sober handbook 1 Comsrompsm .4 receive personal correspondences. Outgoing mail can be dropped off to the receptionist. Westminster wiil provide postage and strange for pick up. do es not contain hazardou member, Wesuninster will cost to you. We will also free times. Phone calls are limited to - opened by the patient with as authorEZed staff member to ensure it 3 materials. If jrou choose not to have your mail opened with a staff send the correspondence or package hack to the original sender at no retm'o mail to the sender if it is received otter you have left the gamma aim Possess; sLngoNro Deuces House phones are available at designated areas on the unit and will be ?lmed on during speci?ed ates and may he monitored by Reeotrery Support Specialists NOTE: The ?rst 5 days you will need approval from your Primary rtherapist to use the phones durisg ?ee time. Cell phones will he secure 1. Ifyou bring them to treataieot, we will secure them in a. locked room so they are safe until the time of discharge. Ifth'ete are instances where you need aooess to your personal phones, this will be approved by your clinical team and aeeommodations will be E?Readers withoot aocessi For everyone?s safety or riionsible for_ any articles le? on sitelafter discharge. Clothing and/or Westminster cannot be valuables not claimed wi om For safety purposes, West designated smoking areas to smoke. - Patients are permitted to 1 meet bring in'new, unopei aooesso?es. The charging order to ensure it meets so 0 the internet are pem?tted during free time. comfort, valuables, money, jewelry, etc. should be sent home. 30 days of discharge will be donated.- I . .C mlmter' Is a smoke-free building For your convenience, there are outside Please check with a staff member if you are unsure of where so e?cig?rettefvoporizers, however, for the safety of all patients they 16d and labeled eweigarettes/vaporizers, bottles of e~liquids and devices must be assessed and approved by sta? upon admission in fety measures. Patients are pern?tted to utilize vaporizers under the some guidelines as cigarette smoking, outside with staifio designated smoking area during scheduled breaks. Staff will secure e?eigare es and vaporizers when not being utilized Patients are out pemlitted to build their own coils 0 bring any materials with them to build coils during their stay Wax vapes,? oil vapes, e-hook In order to ensure 3. seem areas to ensure the safety ,and herb vapes are not allowed. CIN environment, video monitoring will be used at all times in common security and maintenanoe of a, therapeutic environment. At no time will there be video 'monitrning 1n the bathrooms, showers, or bedroom. Your room will be servic ed daily by housekeeping staff. We ask that you keep you: room neat. Please do not tape anything to the walls, lamps and furniture. Please do not fema?ge the ?unih?e. LAM Westminster offers ?'ee laundry facilities All patients are rewonsible for their personal laundry. Laundry facility' IS loeated Please speak to your Primary Therapist if you need to make arrangements for professional salon on the ?rst ?oor, near the group rooms W. services Patients are not Rermi?ed to perform these services. Razors will be stored by 31 eff and available daily by request to RSS during free time. Monday Tuesday'- Wednesday Thursday Friday Saturday Sunday 12?Step or Alternative Meeting 12~Step Meeting or Group Spirituality Individual Sphimality - Individual Spirituality 12-S?Iep Meeting or Group Sphituality Individual Spirituality 12~Stefz or Alternative Meeting 12-Step or Alternative Meeting 12wStep or Alternative Meeting 19 12~Step Meeting or Greup Spitituality 7:00pm 3:00pm mom?3:009:11 8:00pm~9:00pm I 7:00pm? 8:00pm 8:00pm;? 9:00pm 7:00pm? 8:00pm . 8:00pm 9:00pm 7:60pm 8:09pm 7:00pm 8:00pm 7:00pm 8:00pm .u donmo mum . . LIE i I . . In the Rooms Meeting Guide Steps Away RI. {?318 Eaehipe?ent receiving services at Weekninster shall have the following rights: ..1. such consent for To be noti?ed of rules and regulations the facility has adopted: governing patient condoet in the fee' ty. To be informed of ervieesevailable lathe facility, of the names and professional status of the personnel wording andfor responsible for the patient?s care, and of fees and related charges, including the payment, fee, deposit, and refund policy of the facility and any charges for covered by so?rees of third~perty payment or not covered by the facility's basic rate. . . To be informed if facility has autho?zed other health care and educational institutions to participate in patient's treahnent, to know the identity and ?motion of these instimtions, and to fuse to allow their participation in the patients treatment. - To. receiVe from th patient?s physicians or clinical practitioneds), in terms mat the patient understands, an ex lana?on of his or her complete medical/health condition or diagnosis, recommended tree ent, treatment options, including the option of no treatment, risk(e) of - treatment, and exp cted result(3). . - - To participate in planning of the paiient's care and treetlnent'and to refuse medico?on and treeonent. . To participate in xpetfimentel research only when the patient gives informed, Mitten consent to such 13 'eipa?en, or when a guardian or legally authorized representative gives incompetent patient in accordance with law, rule and :egl?etion. 11' individually or as rep?sal. 9. 10. To be ?oated with dignity, individuah privacy - ii. To not be. required treatment and is To voice grievance the governing out] To right to con?de 3 or recommended changes in policies and services to facility personnel, lority, andfor outside representatives of the patient's choice, either a. group, ?ee from restraint, interference, coercion, discrimination, or To be ?ee from mintal, sexual and physical abuse, exploitation, coercive acts by staff and other patients 1 1nd ?ee from use of resn?aints unless restraints are authorised. otial treatment of information about the patient. courtesy, consideration, respect, and with recognition of the patients 1ty, and r1 to privacy, including, but not limited to, auditory and visual to perform work for the facility unless the work is part of the patients Jerformed voluntatily, the therapeutic bene?t is documented in the treatment plan amiis otherwise to accordance with local, State, and Federal laws and rules. - 12. To exercise civil and religions liberties, including the right to independent personal decisions. 13.To not be discrin orientation, disabi to pay,- or deprived 14. To be transfened other patients, or 1 failure to pay room by sources of thirc looted 21th because of age, race, religion, sex, notionality, sexual ity (including but not limited to, blind, deaf; hard of hearing) or ability of any constitutional, civil, and/or legal rights. 31: discharged only for medical reasons, for his or her welfare or that of taff upon written order of a physician, or other licensed clinician or for red fees as agreed by the client at time of (except as prohibited carts paymnt 15. To be noti?ed on editing and to have the opportunity to appeal an involuntary dischatge. 16. To have access to facility?s policies 1 17. To be assured sec and obtain a copy ofhis or her clinical record, inaccordance with the 1nd procedures and applicable Federal and State? laws and rules. nity in retaining approved personal items as space permits, unless to do so would be or would in?inge upon the rights of other patients. 18. To be allowed Vi iting time at reasonable n1 accordance with the patient neanneni plan and, if criti 3! ill, to be allowed visits ??oxn his 01 her family or legally authorized representative at in the patients 01' 19. To receive prom time, unless medically contraindicated as documented by a physician 'cal record. medical attention. 12 you with notice of its legal duties and privaeypraotices with respect to your health information. . Effective Date of This Ne tics: armory-3, 2016 How Westminster may Use or DiscloseYonr Health Information:- Weshninster collects health information from you and stores it within Westminster as your medical record. the medical reeor ?3 medical record is the property of Wesnninster; but the information in belongs to you. Westminster protects the privacy of your health information. The law permits Weekninster to use or disclose your healtli information for the following purposes: 1. Treatment. If another treatrneni provider has previously been involved in your treahnern, or is going to be involved in the ?rture, we may want to disease your case in order to coor authorization! diagnosis, _ph treatment at may involve therapy is it calls may also -2. Pmeni. If treatment de rendered If Assistance, - order to meet agencies who are being mai 4. Noti?cation to care between us, however, this will only he done with written nsent ?om you, or in an emergency situation. The kinds of health care may disclose about you in such circumstances could include your ician assessments, lab results, progress in'treatment, etc. During your estminsfer you may also be involved in group therapy! . This technique ?scussions of a personal nature within a small group" Setting. Group dely accepted and often bene?cial therapeutic tool. Followup phone be done after treatment, however only with authorizationfoonsent from 3 book after your discharge. are covered by health insurance, we may disclose diagnostic and to your insurance provider in order to obtain payment for services are assisting you in applying for health coverage, such as Medical may need to disclose pertinent infomation, such as work history, in Ilglhility requirements. . Care orations. Your medical record may be randomly inspected by onduct quality assurance reviews to engine that high standards of care tained. . "d communication with family. Only with authorizationlconsent; or in an emergeney may we disclose your health infonna?on to notify or assist in notifying a family. me care about yo r, your personal representative or another person responsible for your location, your general oondition or in the event of your death. In an emergency sit ration, including if you are transferred to another facility for medical or family or no, we will give you the opportunity to object to noti?cation of your nail representative. However, if you are unavailable or unable to agree or object due medical or reasons, our health professionals Will use their bestiudgmen 5. Regng? eel?b): lag. As required by law, We may use and disclose your health information. in communicatiOn with your family and others. 15 form where we must follow-up regarding health concerns, such as test .. disability; repo the Food and medications; and hiberculos minimum nece Health oversi proceedings. itidicial and ad] the course of ar . lag enforcemt of?cial for par}; or nn'ssing p?c enforcement pu 10 Deceased nets: Public health. 2 health anthoriti: is required by law, we may disclose your health information to public :5 for purposes related to: preventing or controlling disease, injury or child abuse or neglect; reporting domestic Triolence; reporting to Drug Administration problems with products and reactions to reporting disease or infection exposure, such as HIV, AIDS, hepatitis, ?I?hese disclosures are done In a con?dential manner with only the or)! information provided to required public health authorities. {it} activities We may disclose your health information to health agencies during the ?cdurse of audits, imestigetions, inspections, lieensure and other ninistrative proceedings. We may disclose your health infonnation in administrative orjudlcial proceeding. . ht. We may disclose your health information to a law enforcement ones such as identi?ing or locating a suspect, ?lgitive, material witness . :?son, complying with a court order or subpoena and other law rposes 11 information We may disclose you: health information to coroners, medical examiners and funeral directors. - 11-. Organ donatidr in procuring, h: 12.. Public safe to prevent or 1e person or the 13 Worker 3 com information as We may disclose your health information to organizations involved taking or transplanting organs and tissues . He may disclose your health information to appropriate persons in order seen a serious and nominent threat to the health or safety of a particular metal public messed on With your authorization/consent We may dis close your health ecessary to comply with worker compenSation laws 14. Marketing. may contact you to provide appointment reminders or to give you information a at? other neonate-ate or bene?ts and services that may he - ofinterest toy u. 15. Change of CW aerobic. In the event that Wesnninster is sold or merged with another Organization, GWSL '16; Business Assn associates for, contracted, We - We?ve asked th our health infonnation/record will, become the property of the new states. There are some services?that we need to centraet with business such as consultant and attorney services. When these services are may disclose your health information so that they may perform the job em to do. To protect your health information, we require these business associates to appropriately safeguard your infomtlon. 16 When May Not Use or Disclose Your Health Information Except as deso?bed 111 this Notice ofPrivaey Practices, Weekninster will not use or disclose your health inforfm?on without your wntten autho?zation If you do autho?ze Weshninster to us revoke your author or disclose your health information for another purpose, you may alien in writing at any time. . . Your Health Information Rights 1. You have the to request restrictions on certain ?eas and disclosutfes of your health information. estrninstor is not required to agree to the restriction that you requested - You have the to receive your health intonnation through a reasonable alternative means or at altemative location. It is the policy of Westminster, however, that all such requests put in whiting. A reasonable fee will be charged for copying your health informa 'on. . You have the 'ght to inspect and copy your health information Howewar, it is the . policy of Wes heater that eaell discipline sits down and {eviews their notes with you. You have :1 Il t?to request that Westminster amend your health infonnation that 15 . incorrect or in mplete Weshninster is not required to ohange your health infonnation Land will provi 6 you with infomlation about Weshninster a denial and how you can disagree with denial. You may matter that we provide you with a Written accounting of all disclosures made byes during provided by 0 following type health care on other individ time period for which you request (not to exceed 6 years or for any - date prior to April 14'11 ?2003) We ask that such requests he made to writing on a form n' faoility Please note that an amounting will not apply to any of the of disclosures: disclosures made for reasons of h?eatrhent, payment or rations; disclosures madeto you or your. legal representahve, or any involved with your care; disclosures to correCtiooal instimtions or law enforcement oials; disclosures for national security pmposes, and disclosures made with written a ma?onfconseot. You will not he charged for your ?rst accounting request on an 12-month period HOWever, for any requests that you make thereafter, you will be oh god a reasonable, cost-based fee .For more infomationabout this rightpaper copy of this Notice of P11va Practices. Changes to this Notice of Privacy Practices Westminster reserves the right to amend this Notice of Privacy Practices at anytime 1n the future, and to .nake the new provisions effective for all information that it maintains, including infonIta tion that was created or received prior to the date of so eh amendment. Until such amend nest is made, Westminster is required by law to comply with this Notice. - Should our payee practices Vohange, we will provide all current and future patients with a copy of the revised Notice of Privacy Practices. V. Complaints Compiamts about information shoul ?3 Notico of Ptrwaoy Practices or how Westminster handlos your heal?l be directed to: Director 0 Quality Control Compliance Recovery Phone: 6 Fax: 617? Yo'u may aiso addxess yo enters of America sauce Boulevard 33, PA 19466 ed with the manner in which this of?ce handles a complaint, you may plaint to: Complaint Lines 74524?5171 24-5599 1r compliant to one of the regional Of?ces for Civil Rights. A list of these of?ces can be found online a: QUICK Modica?m' Assisted The: monitored by a physician, - Bene?ts of MAT include: T0 ASSISTED THERAPY (MAT) apy MAT) is de?nod as the use of medication, preso?bod and - to support recovery from a Substance Use Disorder. 18 a An hopextant tool in treatment to be on mbined with counseling, peer support and 12- Step program .- Reduces the frequency and intensity of cravings I Decreases or bloeki the experience of feeling ?l?gh? or intoxicated Provides edefense neehanism against impulsixre use Naltrexone I a The only oral mediention approved to treat both alcohol dependence and opiate dependence - Nalttexone works a an opioid blocker, preventing the reward of getting high . Naltrexone reduces the urges to use alcohol or other drugs, and reduces their pleasurable effects I Will?not make you sick if you drink alcohol or use drugs, and will not reduce the effects of there, such as itjpaired coordination andjudgement I Nalu?exone does 11 prevent the good feelings from naturally pleasurable activities - Starts working 1-3 hours after taken and stays in the body over 24 hours Vivitrol I The longwlashng in ectable form ofNalttexone is Vivitrol (approved for use) 0 Lasts lmonth per PrefeIIed 1r etched because it does not require the patient to remember to take the: . medication . 0 Cannot be anipuleted by not taking it if a patient has the urge to use . Side E??eels 0 Como d?'emporary: Fatigue, nausea, headache dizziness,' Insomnia, tenderness injection site enfMere Senous: Liver toxicity, depression, suicidal thoughts or . I Precautions . 0 To avoid dden- opioid withdrawai, the patient must be clean from opioids for 7~ 14 days he re stall-tang NahIexone. Sudden opioid withdrawal "can be severe and may req hospitalization 0 Do not try 0 overcome this block by over?taking large amonnts ofopioids. This forpein ould knew the precautions of MAT 1?9 MAT and Recovery a Prolonged use of alcohol and other drugs can change the way the brain is formed and structured. MAT eatanent and positive coping skills can he used throughout treatment to restore and rob once the brain?s structure. 0 Committing to Vi 'trol can save lives; The rate of overdosing by eontim?ng to use heroin and other ioids is grossing on an epidemic letfel. The rate of relapse on these substances is stag ering. .- - - I Receiving the Vi 01 shot prior to discharge from inpatient treatment is highly recommended to elp prevent the high likelihood of relapse. Individuals who used MAT had relapse rates .5 0% lower than thosenot taking anything. Thus, had a much better chance at long-tee 11 recovery: with MAI. - for the ?rst 30 to 90 days of treatmth can aclci support When conventionnloiethods of recovery alone are not enough; MAT may be the missing link . a Helps patients live a life ?ee of pain and manageability of alcohol and other drag - addiction -. . - 20 you with notice. of its legal duties and privaoypraetices with respect to your health information. . Effective Date of This No tine: January 3, 2016 How Weshninstel may Use or Disclose Your Health Information: Westminster collec ts health infonnation from you and stores it within Westminster as your medical record. the medical reeor information. The 1aw permits Weshninster to use or disclose your health information for medical record is the property of Westminster; but the haformation in belongs to you. Weehninster protects the prions}? of your health the following pulp ases: . . . . Treatment. If another treatment provider has pzeviously. been involved in your treatment, or is going to be involved in the future, we may want to discuss your case in order to coo: to care between us, however, this will only he done with written authorization! nsent ?om you, or in an emergency situation. The kinds of health care information diagnosis, 'ph treatment at may involve therapy is a may disclose about you in such circumstances could include your, ician assessments, lab results, progress in neatment, etc. During your esoninster you may also be involved in group therapy, This technique isonssions of a personal name within a small group setting. Group dely accepted and often bene?cial therapeutic tool. Followup phone calls may also be done after treatment, haweVer only with authoxization/consent from ,"ons where we must follow?op regarding health concerns, such as test aback after your discharge. Eament. If are covered by health insurance, we may disclose diagnos?c and to your insurance provider in order to obtain payment for services rendered. If are assisting you in applying for health coverage, each as Medical Assistance, to may need to disclose, pertinent information, such as Work history, in order to meet Regnlar Healt agencies who are being main Notification a an emergency, a family morn Iigihility reqoireznents. 1 Care goerations. Your medical record may be randomly,r inspected by conduct quality assurance reviews to ensure that high standards of care ,tained. "d communication with family. Only with Vautho?zation/eonsent, or in may we disclose your health infonnation to notify or assist in notifying oer, your personal representative or another person responsible for your emergency 3' 'on, including ifyou are transferred to another facility for medical or care about yo; location, your general Condition or in the event of your death. In an family or pets or object doe sons. We will give you the opportunity to Oh] eat to noti?cation of your anal representative. However, if you are unavailable or unable to agree 0 medieal or reasons, our health pro?tssionals will one their best judgment: in communication with your family and others. Rew? ed-bx 1m. As required by law, we may use and disclose your health information. 15 6. Public health. As required by law, we may di?eldse your health information to public health authorities for purposes related to: preventing or o'oatrolling disease, injury or disability; reporting child abuse or neglect; reporting domestic violence; reporting to the Food and Drug Administration problems with products and teactions to medications; anti reporting disease infection exposure, such as HIV, AIDS, hepatitis, and tuberculosis. TheSe disolomnes are done in a confidential manner with only the mininnzm noses sary information provided to required public health authorities. 7. ?ealth oyersiglait activities. We may dis close your health i?formation to health agencies during the we so of audits, investigations, inopeotions, lioensure and other proceedings. ninishative proceedings. We may disclose your? health infonoa?on in enforoem at. We may disclose your health information to a law enforcement of?cial for see such as identifying or locating a suspect, ?lgitive, material adoless or missing on, complying with a court order or subpoena and. other law enforcement ses. . . - 10. Deceased pet-so 11 information. We may disolose your health information to soreness, medical exaa?nexe and funeral directors. - - . t- We may disclose your health information to organizations involved ll. Organ donatim in lamenting, hawking or hansplanting organs. and tissues. ill?Public safe . He may disclose your health information to appropriate persons in order to prevent or 1e seen a serious and imminent threat to the health or safety of a particular person or the one-rel public. 13. Worker?s com}, easation. With your au?iozization/oonsent we may dis close your health . information as necessary to comply with worker?s compensation laws. 34. Marketing. may contact you to provide appointment reminders or to give you information a ut other treatments or bene?ts and services thetmay he of interest to you. - - . - 15. Change of Ownership. In the event that Wesoninster is sold or merged with another organization, you; health infomatioofrecord will, become the property of the new owner. - - - '16; Business Assoeiates. There are some services that we need to contract with business associates for, such as consultant and attorney services. When these services are contrasted, we may disclose your health information so that they may perform the job we?ve asked them to do. To protect your health information, we require these business associates to appropriately safeguard your information. . 16 When Westminst May Not Use or Disclose Your Health Information EXcept as desorib inthis Notice of Privacy Practices, Wesnninster will not use of disclose your health info tion without your written authorization If you. do authorize to as? or disclose your health information for andther purpose, you may revoke your author nation in writing at any time. . . Your Health Infoll'mation Rights - 1. You have the ri to request roan-lotions on certain ones and disclosures of your health information: Weshninster Is not required to agree to the restriction that you requested. You have the to feceive your health information through a reasonable alternative means or at an alternative location. It is the policy of Westminster, however, that all each requests I put in writing: A reasonable fee will be charged for copying your health informa? ion. - - You have the Light to inspect and copy your health hlfonnation. HoweVer, it is the policy of West nineter that each diSoipline sits down and reviews their notes with you. You have a night?to request that Westminster amend your health infannation that is incorrect or indompleto. Westminster is not required to change your health information and will provide you with information. about Weshninster?s denial and how yoncan disagree with the denial. . . at that we provide you with a written accounting of all disclosures made by us during time period for" which you request (not to exceed 6 yeaxs "or for any date prior to ril 14m, 2003). We ask that such requests be made in writing on storm .. of disclosures: disclosures made for reasons ofheannent, payment or latices; disolosuxes made to you or your legal representative, or any other hidivid involved with your care; disclosures to correctional institutions or law enforcement 0 plate; disclosures for national security purposes, and disclosures made with mitten a orizationfconsent?. You Will not be charged for your ?rst accounting request in an 12~month period. However, for any requests that you make therea?er, you will be oh god a reasonable, cost~based fee. For more information about this right, see 45 GER.- 164528. . You have a ri to a paper copy of this Notice?ofl?livacy Practices. Changes to this otice of Privacy Practices - rese es the right to amend this Notice of Privacy Practices at any time in the fumre, and to .. the new provisions effective for all information that it maintains, including infonne tion that was created or received prior to the date of such Until such amendment is made, Westminster is required by law to'comply with this Notice, - . - Should our privacy practices, change, we will provide all current and future patients with a 17' copy of the revised Notice of Privacy Practices. V. Complaints Complaints about this Notice of Privacy Practices of how Westminster handles your health information should be directed to: - Director 01 Quality. Control 3; Compliance Recovery Centers of America 2701 Ron King of Pr If you are not sa?-s submit a fennel co Waehingt You may also eddiess yo of?ces can be foun QUICK . senor: Boulevard ussia, PA 19406 ?ed with the manner in which this-of?ce handles a complaint, you may mplaint to: - - . .. ofHeaIth and Human Services E: a: '11, DC 20201 compliant to one of the regional Of?ces for Civil Rights. A list of online TO WDICATIOH ASSISTED THERAPY (mi) Medica?on'Assistod The :apy MAT) is de?ned as the use of medication, prescribed and - monitored by a physician to support recovery ?ne; :1 Substance Use Disorder. Bene?ts of MAT include: 18 a An important tool in treatment to he co mbined with couoseling, peer support and 12- Step program . - ey and inteosity of cravings the experience of feeling 'gh" or intoxicated 0 Provides ?a defense eohanism against impulsive use - Naltrexone a The only oral medi a?on approved to treat both alcohol dependence and opiate dependence . Naltrexone? works I an opioid blocker, preventing the ieWard of getting high. Naltrexone' reduce the urges to use alcohol or other drugs, and reduces their pleasurable effects - I Will not make you ick if you drink alcohol or use drugs, and will not reduce the effects of there, such as aired coordination and judgement a Naltrexone does 11 prevent the good feelings from morally pleasurable activities Starts working 1-3 ours after taken and stays in the body over 24 hours Vivittol 1- The longnlasting estable form ofNalii'exone is Vivitrol (approved for use). - Lasts lmo thper injection 0 Preferred ethod because it does not require the patient to remember to take the medication 0 Cannot be anipulated by not taking it if a patient has the urge to use - Side Effects - 0 Como tenderness 0 Loss Co behavior,' . Precautions d??emporary: Fatigue, nausea, headache, dizziness, insomnia, injection site onfMore Serious: Liver toxicity, depression, suicidal thoughts or jection site reached?sometimes serious and needing surgery '0 To avoid dden opioid withdrawal, the patient must be glean from opioids for 7? I 14 days he re starting Nalhexone. Sudden opioid withdrawal can be severe and may require hospitalizationovercome this block by over-taldng large mounts of opioids. This can lead to accidental overdose, serious injury, coma, or death. 0 Naltrexone is not pain management. Patients will still need an alternative method for pain management. . a Support Network - . MAT req a strong support including someone who will make sure that the pa eat continues to take their medication regularly 0 Supports ould new the precautions of MAT .19 MAT and Recovery I I Prolonged use of alcohol and othet: drugs can change the way the brain is fonned and structured. MAT eatment and positive looping skills can be used throughout treamlent to restore'and reb once the brain?s strucmre. . Comn?tting to Vi 'trol can save lives. The rate of overdosi?g by continuing to use heroin and other ioids is growing on an epidemic level. The rate of relapse on't'hese substances is stag ering. Receiving the Vi ttol shot prior to discharge from inpatient treatment is highly recommended to 31]) prevent the high likelihood of relapse. Individuals who used MAT had relapse rates lower than those not taking anything. Thus, had a mueh better recovery with MAT. MAT for the ?rst 0 to 90 days of treatment can add'support - When convention methods of recovery alone are not enough, MAT may be the missing link . Helps patients live a life free of pain and unmanageabi?ty of alcohol and other drug addiction . ZU Cimibal Use of E?endado?eieaga Fnjeqtable Nal?'exona in the Treatment of Opioid Lisa Uisqrd?n A Brief Guide: TABLE KEY FEATURES c1]: APPROVED FOR-TREATING - OPIOID - .. 3. - - - - Morality Cmmulprn?nn?; 1 'quumay of - Rania den?nl?m?an ?nr?nwa'nular?ll?} Ilia glut?al 'jy as: llguld @mmrateg-tabiat 'nr oral Oralytablstor?lm isdimohed Martha iongue. ELJpI?umrplainn Dali)! Da?y?{atso alternative ddalng realms}- Whom? Huck-Eh: ar' . Any Minimal who}: imaged to What WHSA-ommad OTPE Ir: Dispense ma?IcInage [9.51; phgaiclm physician for dalb'adn?nlstir?on either an 5123 ad?ic?anmedicine or a?dic??an andfar assiata?xit. nurse practitioner} may preamble stabla patina-its. at??oma. template spedai'uamm In qualify ?x the Tandem! ad??ntst'a?nn by gna??ad staff. - prasc?he'bnpramrphiml but any pharmacy can the gamma. Thererana nu special requlmments farsta? mmbars whc: dispense bupranorphina undeir the . supervision Of a wavered Fhmaoipglc Opioid antagonist Opioidagur?st a?dd partial agonlst . Sammy Bnpranorphma?a pgr?tlax Egon-gar effact re?gveq . Mihdramii maui?rgg 1?qu cessation at apiplda. Thig mama pmpanxw?i'lnmqa a swab-urns g?acu'la va?tdrawal In that presence aflong-ac?ng aphids Dr sqf?dent pf fuli agonisia .Naimtmm an apluld m??nlat. Ea . . sm?mwaddad it to make ma 1 . - pmduct less-like? to he abysiad by Inlet-?an. Tabla. 1 Hgf?ghla some! proper?m of anachmedlaauon. It doze nut pm War?: and is not hiandad as mam Iqrtha package Imam c-r Omar drug raferannqaogmas used 5): Wafer canard pagkage mamas}. For pa?en?n?ama?an ahaut mm and ?ber dmgs, 9131!: the N?gttunal Librarynf Medlmia . W?nmer a'madlwl?on monk! be: prescr?watl and an Wat muntare-nmum Lg hg'dis?nsad nah-men an individual 'and his al? har ma?a sate pmld?r. T?a pram mfan?a?b?n Here is; not ambs?hna fol-[ha alluia?n?aju?g'msnr, ?nd-W Na?unal Insilhttas af'Haalih and SAMHSA am: no for use ofthg infatuation lathe carter lndi??u?l pa?dm. Nalhexma mimetamamaa mu aad13amalsuam?abramda?v dogma. - 21 Pre?crihing a {f clinical'uaas?daaf Canadatos Extended-Release: {gnawing opiql?i suggastbmo?m far. panama mare experiencmg Increased siresa or char ralapsa?sk?. visiting places m?prsviaus drug nag, loss of spouse, loss of $013}. Approp?aba foi- pa?enta who hav?q bGE'gn daW?a? imam o??ids and w?qam heihg team fora aimh? use. r11?. maven?oh? n? relapcisa'to opjold ?zs'e disor?jer- . addiction. in elha do m2 Damnation am} Patients whO'are motivated {a adhere tn the 1121mm 'pian and who have no to methadona?wrapy. Methadone should be pgrLofa fcbm?reh?ansbxe manager?ent'?ro?fam ??aeit frigindaa Bupreamrphinn 'Tfaatmenfcf?d?i?id nepfandance. - 'PatLeribs who are motivated to adhere to 2113 traatment plan and who avg cantata] ndlca?ona to therapy. ?hauld hapart ofa comprehensive 'ma'?aga?iant pmgram that ihgiudea .3L1pport. Edema-release rialtnaxpnashould be part . r3? apomprahemive that Other 3530a Qandidates [minds gamma with a Short: or ?633 mew-mgwon mew mwho mug: demonstrate-to pmf?savfprigl mama-Warlr?haljps?ca ?of?cials that their ?akaf use 151cm. If Coi?itr?lngilcsi?ons Wh?l?at?d ?a?erifs. Fabeiidh? IQng- t?fm GmhaaMcatad in panama who are engaged in sun-pent qpioid use {as Indicat?ad?bx Balf- report are posl?ya winadrugscreenmnr who are 017' methadone maintenaqw?u?rdpyi a?s-waii 39; in those wrre'n?? Q?dld??mdrayal. Gdntafh??oateq pgtianw with a mastery-cf camamgalhyiwllulpsa. tawny mmponanfa of?te d?uentcd Shauldnot tan-patients moss body mass pmclu?as'?? Imec?on with the z-Tnci': needle pm?dad; Inadvattant aubwtana?ous - ?e??pn may cauaa?? seveieirijec?an site rean?an. should nqtba given in anyunaalkargin ta I nalh-axona? . Q?nfxalndicated in palladi?wm?ar? ?hyfz?rsan??lve to m?lhgdune wide or ahyro?mr qure?ja?n?n methadone disk?asr powda! or ?1qu chmenh?ata. Contraindicatad?ln - the abganca-cf feauadta?ia? equipment gr in unmuntfol?gdvsejt?ngs) a?ndih f[isthmus With war parmhla. In any pa?entwho has or ls - su?spectad cf 22 Con?dndiaatadmpatiani? who ara'hypersans?hge_ mobupremrp?inaprnaluxona. rug Considerations - disease, n?ndea?eta weavers rate: Inje-olzulyin Ueewtth oen?onhde?entee?heo?vellter hnpeirroent, dodwomen of .m?dbeermg age. In the event of or . stone ot?aoote hepatitis.- As wit: any 11:! injeotton, Itdectable neitmxone should be used caution lh patients with thromhooytopente or any coegt?etlon disorder hemophilia. devote hepatic tantra): such patients ehqud . be aloeety rrmItored for 24 hours after doses of optoige after teammate-It: . extended nellr'exoee. We oouid wealth: poieh?elljr life ?mtering opioid Intomelton end werdoee it previously tolerated larger doses are administered Brimstone shook: were patients the: overdose may reeuJE?ofn trying Movement-reopen blockade emote ofnaitrexone. elderly and debilitated patients. patients with Wow?w? F'ettente may become sensitive to tow: Methadone 7: Melhedone should be need with caution-?n heed injury or {hot-ended ln??eoferiel. prodeuie; - padente who are totem-I to be sensitive to center moosewtem depressants, ouch es _?:ose with oerdioveecuio? renal, or hepatIo end patients: with oomorbld - conditions or oonoomltent medtee?one that may? predispose to dr reduced ven?lehory drive. Methadone should heedn?n?rslorod with caution The label moieties worming about eoomotenoe that may preclude driving oropem?ng eqt?pmerit. - .M?on le 'reclulred in mm pe?e?te With potyoubetonoe nee and those who hove severe hepatic: impelrm?nt. 1:0qu - respiratory emotion, or head injury. - Sigm?cent and death have . doomed In association Mth?bupreoorptiias: per?oulerly edmhletered intrevemmty or in commotion with hemdfezepmes or other central system demerits: {including alcohol) 1 Buprenorphine may precipitate Emmi ?initiated . before patient 1: to opioid portion-orig: in The lobe! includes ammo about somienoe that may preclude or operating eqqument. Use In moment and Postpartlom Woman Pregnancy: FDA pregame; category 0* wine?tog: Transfer ofoeltr'exooe end or:- neltrexol into human mitt has been reported with oral neltmona Beoedse mime! studies have shown. that neioexone hes a edema! for ?d?no?gmlolty and other serious adverse reenter-Is In owning infonts. en lndivtdweltzod .treetrrieet decision mould he made We. norm; momer em need to dleoomlm'te breast feeding or discontinue edit-atone. Pregnancy: FDA oregoenoy oeoegonr .. Methadorte hoe been teed during breedenoyto emanate healthy pregnancyooteomeo formore than 40 years. Neonatet abstinence emit-owe. may newborn Infants of mothers who resolved mediation-easiest] heetnentwtih mittodonoddring pregnancy. No iestidg hen-o tqthe fetus has been recognized as remit of - the: therapy but lwwdua?mdmahnent deetetbne helenotng the risk and bene?ts. of therapy ehot?d be made With each pregnant patient. Naming: Medea-e maintained on methadone can breastfeed [f ?ue? are not Hl'v? positive; are not abusing euoe?noee. and do not have disease or infection in which breestfeedlng' to otherwise contraindicated. . Pregnancy: FDA mommy category 9? Neonatal aesthenoe may occur in newbbm Manta ofmothers .who renewed medication-assisted during pregnancy No testing harm to the fetus hes - been recognized. as arewlt?otme' therapy but . mm: d?clelme balancing the risk .mdhene?ie of therapy shouht be made with eeoh? pregnant patient. Nursing: Buplerm?t?ne end its metabolite are presem In low levels in human me: and Infant urine Available data ere limited but have not 'ehovin adverse reaotlone in breastfed Infants, Potential for Abuse and Diversion No Yes . 788 - .soueo?eed'z?i I Anibal studios have shown an adverse oftect on thofetue and there are no adequate. Welboonoo?ed undies in hunene. out ootentiel fished}: mow mt use cf?lh? era: In some moment 23' . OVERDOSE PREVENTIOE 1) meow THE OF 0 WEB 0315. SA VE A LIFE. Signs of opioid overd may include: - Breathing that is slow shallow or no breathing at all . . . Very sleepy and not 1' pending to your voice or touch .- Bloe or grayish skin 0 101?, with dark lips and ?ngernails Snoring or gurgling 5 ads If there are 1' an overdose: - Tap, shake,iand shoot ?he person to get aresponse? . Ifthere is still no reap use, rub knuckles on the breast bone - Ifno or little response 02111911 Opioids? include: heroin, codeine, ?ntanyl, hydrocodone (to. Vieodin). hydromorphone, morphine, owcodozze e. QxyCono?rz, Personal), etc. . 2) CALL 9-191. AN 0 VERD 0313? is A MEDICAL EMERGENCY. An opioid overdose-co cause a coma or death within minutes. A medication called naloxone (N amen) eon reverse a overdose and save a life. . . When you call 9-14: . - Give the address - Tellthe'm it?s anover - Stay withthe person. for drug possessioo. so so they eon bring naloxone (Noreen). Gr say, ?_My friend is not breathing." :3 9,1,1 Good Samaritan law provides protection from arrest and prosecutioo While you wait for the amb?lonce: - Do rescue breathing. - Ifyou have to leave 3 person for any amount of time, place the person on their side. . Tell the ambulance so: anything you can about any alcohol or drugs the person line taken. If . you cannot stay, leave oats with the Infommtiom 3) D0 RESCUE BREATHING IF SLOWEE OR 1. Make sure nothing is in the mouth - 2. Tilt head book, lift :hin, pinch nose 3. Breathe in mouth 0 use every 5 seconds GET TREATME .mese IS HELP. You are not alone. The fo Roo?ng resources can help you ?nd substance abuse treatment, prevention services, and information. 24 Massachusetts Substance Abuse Informa?bn and Education Helpline . Free and con?den?zl information and refazrals to public and priVate treatment programs . - Health insurance ma 110th required . Translation availabha in 1401mguages To?free 14300?32? 5050 St?ed 7 days a wa Use MassRei? at 711 or LBW-7206430 a! 711 0r1?80?-720-3480 ww.mms.gov/ a?nghome Massachusetts Overdose revention Resources 9 Free and con?den? {naming on pmventing, recognizing, and responding to overdose is available Training ncludes rascue brea??ng and how to use naioxone (Narcan); a Naloxone (Narcan) 8 available at Speci?c locations statewide. It 15 also available at many phannacies. Ask}! pharmacist. . - To ?nd a naloxone mean) site near you call: 3 Tall?ee wee-32 5059 IITY: UseM?ssR a! 711 or . . Help is available 1? over 14!? languages. For information abnut overdose resources visit gov/dnhlovardu se 25 physician will make ?nal d1 . Gutpatientoptions Ei- risers Title: Continuing (ions Planning Effective Date: March 2016 Manual: Clinical/Gui; natient Related Depenmentis): Poiloy No: 1007 Review/Revision Date: Page lof2 PURPOSE: The purpose of this policy is set, the standards for ore?discharge assessment, continuing care treatment planning, contin agencies, facilities, or indiv POLICY: It is the policy of planning, a continuing care ssessrnent and plan that address the needs, goals along with the indivi . Continuing care oblectives: 1. That each pati treatment tee . ing care treatment provided, and follow?up requirements from accepting. uals who provide treatment. . covery Centers of Americe (RCA) to have as an integral part of'dische rge preferences, and 31 physical and pwchesociel needs to-support recovery post discharge. nt discharged develops a plan for continuing care, in collaboration with the 2. That the prints objectives to posteecute ca rewontinoing-ca re plan are to enhance healthy growth and development in all functions of the patient?s life, and to prevent relapse and re?_ hospitalization 3. Thai: there is a for substance abuse or misuse. continuity of care (handrail) to an outpatient treatment modality that will incorporate iris olvernent in appropriate Selfwhelp programs, intensive out?patient program, continuing en; group, andlor continued individual out?patient professional therapy. 4. That patients requiring additional structured treatment he transferred to an extended care, long term, alternate living, or like, facility for continuation ofmore intense therapy. Thai: each patient shall be followed-up for 12 months after discharge, to determine the progress of the ir continuing rocovery. . Continuing Care Plan The continuing care plan is time of admission, the con components are based on The treatment team, with? each member of the team patients? designated there; continuing care plan. prepared with each patient. Although discharge planning is begun at the timing care plan will be developed over the length of treatment, and its final :he latest assessment ofthe patient, the patients' needs and Preferences. he patients active participation, will formulate the plan with the patient and signing the document. The treatment teem, director end/or intending :cisions as to transfer, therapeutic modalities, and prescribed treatment. The Jist and care manager will be responsible-for coordinating all eSpects of the 3 Outpatient treatment may consist of Individual-or groop therapy, or both, and may include the patient?s family members, and other signi?cant persons, in the patients? recovery. Eli! licmmyikmm?mim Title: Continuing Care Manning Policy No: 1007 Effective Date: March 2016 - Review/Revision Date: manual: Clinlaai/Gutp atient . Page 2 of 2 Related Bapamnen?e): - 2. Each patient will be trongiy encouraged to become actiVely involved with a self- help - fellowship, and to a empt to become lnvoived In a lit?Step recovery program Patients are encouraged to 3118i 3 ""sponmr prim to Discharge 3. The attending physi an {if applicable} may desire to continue to see the patient on an outpatient basis. 4. Patients referred to CA treatment by a or other licensed therapist will be referred a ants needacl additional oversight of a physician. that person pen diScharge, whetherthat person was attending or net during treatment. Reference: TJC CTS 06.02.01, (16.02.03 $5113.01; MA 105 CMR 164.040; MD 10.4104; NJ PA 709.63 .4 .mp1. . no- u. 1??me - nun . -- ?nnu~l:? mum?~? EH Room-"cry Camera #fAmc?m Admissions and Exclusion Criteria - RCA treats adult make and females who are ?l 8 years of age or older and have problems resul?rg ?-om disoroem. It the policy of RCA to admlt patients for treatment without repaid to gender, race, rallgion. national origin, marital status. oroad gander identity or sexual orientation. Patients may also be admitted with and will be heated for mental health iilnossos. All an; expected to be voluntary and prospective patients must make a verbal oommilmant ancl give written consent to complete the: diagnostic evaluations and be involved in treatmant. The decision to admit an mdividoai lies salary with RCA. REA 15 not bound by any contract or other obligation to aoo?ptan individual into lreatrrtont who is inappropriate by Vil'ttle of medical or diagnosis -: a category of automatic lamina?. loo tliat is de?ned bya history of criminal oomlollon. in par Gill-1164.676tG) RCA shall not 66:15: adn?sslon to an individual the individual uses- a medication prescribed by a physician amides RCA's sot-visa or facility. some patients will ha excl udod from 'admloolon to our lnpatlentfrosl dentlal programs. If a potential patient meats any of the criteria listed below, lhon who may- not be adm ittad to RCA inpo?ont programs based upon further sorooning 1- Individuals Lindon-tho age of 18 - Individuals suffering from a currently unstable condition that requiroo a higher level of payol'iiatrlo care. This includes but Is not limited to: persons Bid'llbl?ng active of soblzophronia. hmioidaifaggraosivo behavior. active suicidal idoatlon with a plan, andlor active suicidal ihoughto in which the patlorm cannot contract for safety. who are bod-ridden. unable to participate In olaily programing andlor unable to lake care of their Activities of Daily Living Foroons suffering from a modiooi oonditlom?compiloatlon that Is not able to be addressed in this setting. Gama-at Nonhoapltai Daia?im?on Program Galleria Nonhoopllol Ruidonilal 46151618516? Criteria 1. The Intake andleoutaCtCanlafstalfm?l 1 individuals mustmeot called: from ?oi?l?'?'laDS? S. 'Addlouom individual: moo: mat the 5, ?Addictions. E. Rolalod DloordoI'S' or 100-15 collect all om inbnna?tlon from the poloatlal patient. I: Roland Dis-min" auction or Ian -1o Substanoe Sabotage: Use Disorder-Boonidonoo" as How! as ill-SAM criteria for this level of 2. If the potential pa?ont is ounm?y In fooliily or Use Dhordso-Dopmdonoo'. as well as ASAM minim-this level ogre - money ammo: clinical. dommontaiion will be ofcare. 2. QIWiH'ldrm'aal for 12%:me RCA modioal provider can also 2. speak with the may or ED provider . 3 Staff will obtain Wilton amount from tho palatial potion: lo par?oipotofuily in diagnostic evaluation and Wool. 4. RCA will provide felon} nplloa'm to individuals who are not admitted for any mason lniom?oa?on individuals: should also meet tho (allowing: a) Tho risk of a sworn ammo is present but manageable in thin selling. :13 Evil-tamed or. from alcohol and elm-Ar {clinical inotiluto Assessment .. Normal-- ?Ravisodl summer (or other nominal-obit: standardlzod among Warn] aqua]: 10-19: GR Daily lngootlon of soda?ire hypnotic: or uploldo for our six . mlhs? no daily use Dfam?'ml' mind knowoto have 116 mm withdrawal (ole?n! homily monitorino in maiablo. ?ooded} with no accompanying diatomic: ?12thch lmpok?oalmont: OR Daily Ingestion of sol-lotion hypno?os or oplolds above lhu recommended ?mapeu?o oasago level for at [666:4 woolen {close handy monllo?ng is available fl ?ooded}. with no accompanying domain": OR . The hdivlduai noon high dome: of oral molar nasal stimulants. indict mayo orlniacla :r?mulmto all [out moo a do? should also meotONE a}langIr?dWU? lo assumed as being at hinlma! to no risk of moral-vol as . y? - (1) mom {Clhloal Mamba Wl?'ldrawal minim - Alcohol Realism} scoro for olhar comparable cation than 10 ?following 8 how: coahs?nmoafrom alcohol without rrledioallon: (3R Blood alcohol I: 0911336 and no withdrawal alga-:5 or pmam?l which mantra madloatlm: 0R Sub-acute ofprolmolad Mhdrawol which. can on mono-god wall: wl?lwl dolly mo?oaily managed b} For Individuals with We] smptomo no mom oat/am than moan onion; in Section A. has and respond: positively to mollmoi Euppon and oomfortas manned by decreased ion-notional byline: and of the initial 3. Biomedical condition: and Complications . Shaun: also moot ONE of lilo foEOwlng: a} Controlled alooholldrug we place: In possible danger of sariwo damage to phyaloal health for mymn?mthlomudlca! oondilims continued use ofaloohol oespito En. Romper}: Centers af?morica 2701 Renaissance Blvd, 4lh Floor King. of Prussia, PA 19406 din noslo similar hiolo of diobotos, cirrhosis of the Ivor. Wows or SEMJIBS during nu u. no - .u mun-mum. - ??u-nhnlu 3. a) in uoyolit: pattern of' runs: and is within 7 daya ofsuch drug use: 0R Thet individual has marked lo?mgy hypar nomnolanoa. or high laws of agitation assoohmd with mammal high degrees of drug mama. Biomltliml conditions and Complloaunm individuals about: also meet ONE of tho following: Gordinuari alooho?dmg neoplasm the individual in imminent rimgar of ?nous timing: to physical health in: omm?rtmt himedioal oomdlliona. ti} ?imodiml at addiction (r a armament biomedical Ilium muim medical monitoring, but not mm oars. - wlti?Idrawai, continual: use deaplta him of seizures associated with such use high blood prawn-o or cardiovascular or cardiac problem or continued use within a sell-destructive lifm?lylo whit: or b) Bimeoloai mmplioa?orla of addiction or comment biomedical illness require medical monitoring butmtirrlamtvam to. c} Eindivl?ml a pregnant. or ramming slot: use mum place the-fame in illuminant Worth-away Thu biomedical mpiloa?ona am not aware enough for Levels 3 or 4., taut are au?l?mi?lo distract from recovery arms. conditions which require medical could bah-sated by a Wanna-aw trunnion: providen- 4. Emanatl?ahmml Conditions and Cornp?ohiim . lndhiriuds should also most ONE armefoiimulng: a} Damian andiorothoc amotionalbehavloral aimptoma {2.9 commislvo bottom} on: malm?v interfering with mammal. runway. and ability tolha dogma that ?warm 2% hrm?mmul ls need it: adorns: ammonia and may elicits; b) Themlsamodomia risk {usually medicated habaviorln lira reactant pm) afbehmalm endangering 3qu ?other: suicidal whaniddal thoughts with no saliva plan but a history ofsuloldalgaslrires orhomicldai Mats); ?war mm mm 'mvhum la needed in help file addmaa hm . bohms require omit nowahwr?ary-aa?ng Intanm?ona. family. work, orsoclaiprohlm), door: notaooaptorreiata to lineal-madly af?rm problem lndl?duat l: in need of intensive momma strategies. milliliter; and pmcasaes 'irr hlsmar humadrarta environment - a) The Individual Eves in an envimrm? (9.9. mist or Interpersonal mam-ark) in mob police of?cer member :1?de dosh, nurse omslruo?onworke r. 1553.}. o) The lndivkliml in manifesting rotated to tin-salmon Kansas in the addiction; d} ?onoormitant pe'rsmality ?amers (erg antisocial morality disorder with verbal aggressivehohavlor requiring constant mam-imam; crouch severity . 5. Readiness 10 M9 nostrils minim mum mdior ails-=13 utilise addotlou or: the individual?; ll?a [mg basil}: only available within a 24411? part-gm E. Rolapaa Potential . Jnril'ridmla should meet ONE of the ?lming: a] anlrea history ormunm episodes aka lam in?nitive- level oi cars that halvidual :5 experiencing an Bonita wish: with a curriculum hianai?mtion of addlc?on 93mm lag difficulty primal-ring grati?cation and mialad drugeaaking botm?or); b} The Individual tamed in he Ends-nae: ofdrinking or dragging with attendant more . manners. and E5 In need of professlmalty infected clinical interventions: TM ln?ivrriual that alcohol arrdlor drug us: is: amasslve and has warranted to reduce or control it. but has been unable to do so as long as alcohol androi? drugs am present ?.-EeowerlyEmirmm1t Individuals should meet ONEnftha EoilorMmg: treatment is unlikely to {any family run of immoral con?ict which undermlno: ?t chmgu, familymombers or slanll?lomt other: living with the immune: who madlmixcurraht substance abuse problems and are lately 1a undonnina tho hdivlmai?a recovery b} Logistic lmpadlmonts a. ?lalanca lrom imam-mt mount}.r mobility limitation task If driver's Ema. sin} prad pmtiolpaitorr' in manner-i1 set-vim n; a has insamhra level; Thane lo a damgarof Emma: smal.anri1orsavara emotional moi: or victimization that individuals amt anwmmant will moire memory lunllkoly without moving the individual from this Willem: d} The mdtvidual is Engaged in an ongoing adivity {3.9 minimal Homily in support habit} or compatriot-1 whore omtlnuod Eleni-apt arrdior drug um on tho part at 111:: individual commutes aubolan?nl risk to public 'urpamonat safety {as individual to airilnd pilot, bus driver. gm Recovery [timers 2701 Renaissance Blvd., Floor, King of Prussia, M19495 March 1, 2317 -_March.4, 2317 Case Management and Counseiar Schedule RCA-Westminster CiIn S?perv??r Counselor Counseiar CoUnseior Luuna can Thursday ?u i315" Saiurday 8.39.5pm .. 8:30-5pm 3:30~5pm 8:306 pm 8:30~5pm 8:30-5pm 8:30~5pm 3:30?5pm 8:30-5pm 8:30-5pm 8:30-5pm 9* {tn?9pm 3:20.59111 8:30-5 am Counselor 113m-7prn 11am?7pm llam-me Counselor -9:303m~2pm '10am-130pm Counseiu 1 Case- Managar 9:00-5:30pm 9:00-5:30pm Case Manager 8:0M30pm ?8:00?4:30pm Cas? Manager 8:00-4:30 pm 8:00-4:30pm 8:00-4:30pm? intake Counselor 8:00-4:30pm 1045;003:111 March 5, 201.7 - March 11,. 2017 .. -.-. rl.? ?Tuesda?r Wednesdavfh?m?ar Fri?av Safu?dav Cain. Supervisor s:30~5pm 8:30-5pm 8:30-Spm 3:30-5pm Counselor I 8:30-5pm 8:30-5pm. 8:30-5pm 8:30-Spm Sago-Spm . Counselor - S:30~5pm 3:30-5pm 3:30-5pm 8:30-5pm 8:30-5:3m Counselor 3:30-5pm 8:30-5pm 8:30-5pm 8:30~Spm 8:30-5pm Counselor 8:30am 8:30-Spm . 3:30-5pm sac-sum 3:30-5pm Counseinr 113m~?pm 113m~7pm 11am~7pm 11am-7 pm llam~7pm CDUHSEIDF . l?-aml??m . SEde-Ep; ll . .Laupn Counselor 8:30-4pm Olin. Director . 7:00?5:35 7:00-Spm 7:00?Spm 7:00-5pm 7:00-5pm 10am72pm Case Manager 9:006:3013111 9:00-5:30pm 9:00?5:3013111 9:00-5:30pm - Case Manager 8:00-4:30pm 8:00?4:30pm 8:00-4:30pm 3:00-4:30pm Ewe?4:30pm Case Manager - 8:00-4:30prn 3:00-4:3Gpm 8:004:30pm 3:034:30pm 8:004:30pm Intake Counselor 10:3:30p'm 7 9:30-5:30pm March 12, 2917 March 13, 2017 . 2? .J .gr . . .32. tuesaav mammal? 'Fhursdav mm Sainrdav . 1 um. DUDEWISOT 8:30-5pm 3:30?5 pm 8:33-53:11} pm Counselor ?8:30-Spm 8:30~5pm 8306:3111 8:30-5pm 8:30-5pm Counselor ?:30~5pm 8:30?Spm Stan-Sum 3:30-Spm Counselbr . 8:30-5pm _B:30-5pm 3:30?5:11? 8:30-Spm Counselor 3:30-59:11 8:30-5pm 3:30-5pm 8:30-5 pm Counseior llam-Jpl?n 11a m-7pm 113 m?7pm 113m-7pm 11am-7pm . in.? Ov??am-?l HM Counselnr -.- u? Ciin. Direc?wr 7:00-5pm 7:00-53:11} EEOC-S pm 7:00-5pm 7:00?5pm 11-5pm Case Manager 9:00~5:30pm 9:00?5:30pm 3:00-5:30pm moo?mom Case Manager 8:004:30pm 8:00-4:30pm 3:00-4:30pm 3:00-4:30pm Case Manager 8:00-4:30pm 8:004:30pm 8:00-4:30pm Intake Counseior 8:00-4:30pm 8:03-4:30pm Mar?h 19, 2017 - March 25; 2017 4 ?mplav?g F?sl??hizr *F?Saj?raay "2 CI m..$uperv15mr 3.30633?: ass-slam 8:30-5pm Counselor 8:30?5pm 3:30-Spm 8:3045pm Ccunselor 8:30~5pm sac-slam Cuunselor 8:30-5pm 8:30?5pm 8:30-5pm 8:30-Spm 3:30?Spm Counselar 8:30-5:37: 8:30-5pm . $z30~5pm 3:30-55:11: 8:30-5pm COunseior 11am?Tr?prn 11am-7pm 113 mi? pm Cuumgiu; in nu?} AU ulna. u? O'Q?am .7'nm imam-7 pm 10 arm-13% Counselor Clln. Director 8:30?4pm moo-5pm 7:00~5pm 7:06-5pm 7:00-Spm 'Jz?t?J-Spm Sam-45pm Case Manager 9:00~5:30pm 9:00-5:30pm 9:00?5:30pm 9:00-5:30pm 9305-3013111 Case Manager 3:004:30pm 8:00-4:30pm 3:00-4:30pm 8:004:30pm 8:00-4:30pm Case Manager 8:00-4:30pm 8:004:30pm 8:004:30pm Intake Couriseinr 8:00-4:30pm io-Gpm March 26, 2017 ~?pril 1, 201.7 .. .. a. a? I Tuesday" Wednstiay'rhurad?av .-maay mm 8:30~Spm 3:30-5pm 8:30e5pm 8:30?5pm 3:30-Spm 8:30~5pm 8:30?Spm 3:30?Spm 8:3 0?5pm 3:30-5pm ?8:30?5pm 8:30-5 pm 3:30?Spm 3:30~spm' 8:30?5pm 8:30-5pm 3:30-5pm 8:30-5pm ilam~7pm 8:3015pm 8:30-5 pm 11am?7pm 3:30-5pm 8:30-5pm 113 m??Fpm 11a m?Ypm llam~7pm 1 . 13d; was; 9: 1i EBB-413111 7:00a5pm ?:OO~5pm 9:00-5:30pm 9:00-5:30pm 8:004:3013111 . 8:004:30 pm - 8:00-4:30pm 9:00-5:30pm 8:00-4:30pm 8:00-43 0pm 9:00-5:30 pm 8:00-4:30pm 3:00?4:30pm 7:00-5pm 9:00~S:30pm 3:004:30 pm 9a m?Epm 3:00-4:30pm l?-Gpm 2017 MARCH I MONDAY CALENDAR YEAR COUNSELORS FIRST DAY {31: WEEK Monday Tu esday Wednesday Thursday. F?day Saturday Sunday 01 - oz ca 04 - :SOpm . 30pm ?abbm mam?Sm I Ham-7:30pm 9?5:30pm 96:30pm 1 - 12-830pm 1243012111 - him-10:30pm - 2pm~10:30pm ?432m 9-5:30pm luamu?pm liarIWSOpm 6:3me . . _2pm~m:acpm 95:30pm 1243:30er 17 1 . 18 s-sm' 3-5pm pm -1Dam-Epm .112m?7:30pm il-SSUpm 12-3:30pm amen] 2pm~10309m pmwiD-B?pm pm?iWSOpm 133i Z-Eza?pm i Elam-10:30pm 21 23 24 . . 2'5 l?a rri-Gpm mam-7:30pm 30pm 95:30pm pm-lO?Gpm pm?lo-aOpm :Bli?prn . 945:3me 2pm-lD:30pm 4:309m 96:30pm -B:30pm 2pm-10:30pm Emu-10:3 0pm 27 .30 31 01 50pm 93:30pm . 9-5:3:1pm . 12-330pm F: lam-10:33pm 2pm?1m30pm Emu-10:30pm 2pm1m30pm - . . 4:3me - 9-523me RCA - WESTMINSTER . OPERATIONS - . . . . MARCH 2017 SCHEDULE: INTAKE COUNSELORS - . - summit? SUNDAY MM mast: WEDNESDAY THURSDAY 0830-1?00 hr. - . . -. 163D - 23.30 hr. SATURDAY ist Shift 0730 - 3.600 hr. 2nd Shift 1530 - noon am: Shi'ft 3336a OSBOHRmm? A751 . #13: C551 -C532 A131 A152 c351 6552 A131 {?52 C351 DNESDAY .. RCA WESTMINSTER RCA - WESTMINSTER .. . MASTER SCHEDULE: CASE DRIVING smog? SHIFT DAY 0800 1630 HR. 1230 - 2100 HR. MONDAY I TUESDAY - WEDNESDAY THURSDAY FRIDAY SATURDAY